Presentation Authors: Jiping Zeng*, Ken Batai, Benjamin Lee, Tucson, AZ
Introduction: To evaluate the impact of time interval between diagnosis to definitive surgery on the outcomes of patients with T3 renal cell carcinoma, and to investigate the potential causes of delay.
Methods: Using the National Cancer Database we retrospectively reviewed the records of patients with pT3 renal cell carcinoma treated with radical nephrectomy or nephron sparing surgery between 2004 and 2015. Patients with metastatic disease were excluded. The cohort was categorized based on time interval from diagnosis to surgery. The primary outcome was five-year overall survival (OS), which was calculated using vital status (alive or death) and last date of contact since definitive surgery. Cox proportional hazards models were fitted to assess relations between these intervals and 5-year OS, adjusting first for patient demographics and then for disease severity. Multivariate linear regression was used to search for potential risk factors associated with delayed surgery.
Results: A total of 22,653 patients were included in the analysis. The median follow-up time was 31 months and the overall mortality rate at 5-year follow-up was 42.9%. The median interval from diagnosis to definite surgery was 30 days and 85.3% of patients underwent nephrectomy within 70 days of diagnosis. Patients (n = 3,340) who had a delay of 10 weeks were more likely to die compared with patients who had definitive surgery within 70 days (adjusted hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.15-1.33). This risk was not markedly attenuated after adjusting for confounding variables, including age, Charlson-Deyo score, pathologic stage, grade, and surgical margin status (adjusted HR 1.13; 95% CI 1.04-1.24). In multivariate linear regression analysis, treatment in academic or integrated network cancer center, lack of insurance, and median household income less than $38,000 are more like to have a delay greater than 70 days.
Conclusions: The vast majority of pT3 patients underwent radical or partial nephrectomy within 70 days. Delayed definitive surgery for more than 10 weeks is associated with decreased five-year OS. Treatment in academic or integrated network cancer center, lack of insurance, and low median household income are more like to have a delayed definitive surgery.