The effect of time to nephrectomy on cancer‐specific mortality in pathological T stage ( pT)1b –2 renal cancer
OBJECTIVE: To assess the impact of prolonged time to surgery on cancer-specific mortality (CSM) in patients with pathological T stage (pT)1b-2 N0M0 renal cell carcinoma (RCC) treated with nephrectomy (either partial [PN] or radical [RN]). Within the Surveillance, Epidemiology and End Results (SEER) database (2004-2021), we tested the effect of time to surgery >3 vs ≤3 months on CSM in patients with pT1b-2N0M0 RCC. PATIENTS AND METHODS: Propensity score matching (PSM) and multivariable competing risks regression (CRR) were performed. Subgroup analyses stratified patients according to time to surgery interval (≤1 vs 1-3 months, ≤3 vs 3-6 months, ≤3 vs >6 months), histotype, and grade. RESULTS: Of 16 322 patients with pT1b-2 RCC treated with nephrectomy, time to surgery >3 months was recorded in 3023 (18%) patients. These patients were older (median age 64 vs 62 years) and harboured a smaller proportion of pT2 patients (19% vs 30%). After one-to-one PSM, 3023 (100%) patients with a time to surgery >3 months exhibited a 60-month CSM of 7.6% vs 5.9% in 3023 (23%) patients with a time to surgery ≤3 months. In CRR time to surgery >3 months independently predicted 1.3-fold higher CSM (P = 0.02). Subgroup analyses revealed a dose-response effect, with a CSM increase in 1.3-fold fashion when time to surgery was 3-6 months vs 1.6-fold fashion when time to surgery was >6 months. The detrimental effect of time to surgery>3 months was consistent across all grades but was not evidenced among patients with a non-clear cell RCC. CONCLUSION: In patients with pT1b-2N0M0 treated with either PN or RN, prolonged time from diagnosis to surgery was associated with higher CSM. This association was not observed among patients with non-clear cell RCC.
Authors
- Carlotta Palumbo (ORCID: https://orcid.org/0000-0002-6165-5276)
- Leonardo Quarta (ORCID: https://orcid.org/0009-0008-9523-3400)
- Fred Saad
- Felix K.‐H. Chun (ORCID: https://orcid.org/0000-0001-8486-9536)
- Maximilian Filzmayer (ORCID: https://orcid.org/0009-0005-5715-9965)
- Michele Nicolazzini (ORCID: https://orcid.org/0009-0003-7773-5101)
- Alessandro Volpe (ORCID: https://orcid.org/0000-0003-3377-3782)
- Nicola Longo (ORCID: https://orcid.org/0009-0009-3394-0596)
- Jordan A. Goyal (ORCID: https://orcid.org/0009-0006-4609-8981)
- Gennaro Musi (ORCID: https://orcid.org/0000-0003-0833-9183)
- Michele Petix (ORCID: https://orcid.org/0009-0009-2893-2196)
- Pierre I. Karakiewicz (ORCID: https://orcid.org/0000-0003-1354-5854)
- Federico Polverino (ORCID: https://orcid.org/0009-0007-6218-3761)
- Riccardo Schiavina (ORCID: https://orcid.org/0000-0003-4679-8196)
- Shahrokh F. Shariat
- Calogero Catanzaro (ORCID: https://orcid.org/0009-0004-6265-5288)
- Nick J. Lee (ORCID: https://orcid.org/0000-0002-7166-0503)
- Alberto Briganti
Institutions
- Al-Ahliyya Amman University (JO)
- Goethe University Frankfurt (DE)
- Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT)
- Vita-Salute San Raffaele University (IT)
- University of Milan (IT)
- Comprehensive Cancer Center Vienna (AT)
- IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
- Azienda Ospedaliero Universitaria Maggiore della Carita (IT)
- University Hospital Frankfurt (DE)
- IRCCS Ospedale San Raffaele (IT)
- Weill Cornell Medicine (US)
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT)
- University of Turin (IT)
- European Institute of Oncology (IT)
- Université de Montréal (CA)
- University of Naples Federico II (IT)
- Medical University of Vienna (AT)
- The University of Texas Southwestern Medical Center (US)
Publication Details
- Journal
- British Journal of Urology
- Published
- 2026-09-29
- DOI
- https://doi.org/10.1111/bju.70468
- Primary Topic
- Renal cell carcinoma treatment
- Type
- article
- Field-Weighted Citation Impact
- 0.00