Temporal trends and sociodemographic determinants of time to nephrectomy in localized renal cell cancer

INTRODUCTION: Prolonged time to nephrectomy (TTN) has been associated with adverse oncologic outcomes. We evaluated temporal trends and sociodemographic determinants of prolonged TTN in surgically treated patients with localized renal cell carcinoma (RCC). METHODS: Patients with T1-2 N0 M0 RCC treated with partial (PN) or radical nephrectomy (RN) were identified within the Surveillance, Epidemiology and End Results (SEER) database (2004-2022) and stratified according to TTN ≤ 3 vs. > 3 months. Multivariable logistic regression models identified independent and combined sociodemographic determinants of TTN > 3 months. RESULTS: Among 54,365 patients, TTN > 3 months was recorded in 28% of PN and 18% of RN patients. The proportion of TTN > 3 months increased over time in both PN (from 19 to 36%, p < 0.001) and RN (from 11 to 31%, p < 0.001). Higher rates of TTN > 3 months were recorded in non-Caucasian vs. Caucasian patients (PN: 33% vs 25%, OR 1.49; RN: 24% vs 15%, OR 1.74), unmarried vs. married individuals (PN: 33% vs. 25%, OR 1.43; RN: 22% vs. 15%, OR 1.58), and males vs. females (PN: 28% vs 27%, OR 1.18; RN: 18% vs 18%, OR 1.20; all p < 0.001). Combined assessment revealed highest rates in non-Caucasian unmarried males at PN (40%, OR 2.70, p < 0.001) and RN (28%, OR 3.09, p < 0.001) compared to lowest rates in Caucasian married females (PN: 21%; RN: 12%). CONCLUSIONS: TTN > 3 months proportion increased over time in localized RCC. In PN and RN, non-Caucasian unmarried males are at highest risk of TTN > 3 months. Therefore, specific focus on these highest risk individuals may be warranted within strategies aimed at minimizing TTN.