The effect of delaying nephrectomy on oncologic outcomes in patients with renal tumors greater than 4 cm Journal Article


Authors: Mano, R.; Vertosick, E. A.; Hakimi, A. A.; Sternberg, I. A.; Sjoberg, D. D.; Bernstein, M.; Dalbagni, G.; Coleman, J. A.; Russo, P.
Article Title: The effect of delaying nephrectomy on oncologic outcomes in patients with renal tumors greater than 4 cm
Abstract: Objectives: Delaying nephrectomy <3 months does not adversely affect treatment outcome of renal tumors. Whether surgical waiting time (SWT; time from diagnosis to surgery) >3 months affects treatment outcome for large renal masses has not been well studied. We aimed to evaluate if SWT is associated with treatment outcome of renal masses >4 cm and identify patients who are more likely to experience prolonged SWT. Materials and methods: Data from 1,484 patients undergoing radical or partial nephrectomy at a single institution for a nonmetastatic renal mass >4 cm between 1995 and 2013 were reviewed. Patients with benign tumors and incomplete preoperative data were excluded. The association between SWT and disease upstaging at the time of surgery and recurrence at 2 and 5 years was assessed using logistic regression. Cancer-specific survival (CSS) and overall survival were assessed with landmark survival analyses and multivariable Cox proportional hazards models. All analyses were adjusted for patient and tumor characteristics. Results: Of the final cohort of 1,278 patients, 267 (21%) had SWT > 3 months. Patients with larger, symptomatic tumors had shorter SWT. Median follow-up for survivors was 3.8 years (interquartile range: 1.5-7.4). On multivariable analysis, SWT was not associated with disease upstaging, recurrence, or CSS. Longer SWT was associated with decreased overall survival (hazard ratio = 1.17; 95% CI: 1.08-1.27; P = 0.0002). Sex and tumor size, histology, and presentation were associated with disease upstaging, recurrence, and CSS. The most common cause for surgical delay >3 months was evaluation and treatment of comorbidities. Conclusion: Patient and tumor characteristics, rather than SWT, were associated with disease upstaging, recurrence, and CSS, and should guide the decision to delay surgery when treating nonmetastatic renal tumors >4 cm. (C) 2016 Elsevier Inc. All rights reserved.
Keywords: survival; renal cell carcinoma; nephrectomy; active surveillance; cystectomy; surgical; stage; cell carcinoma; intervention; masses; natural-history; size; outcome prediction; cancer; treatment delay
Journal Title: Urologic Oncology: Seminars and Original Investigations
Volume: 34
Issue: 5
ISSN: 1078-1439
Publisher: Elsevier Inc.  
Date Published: 2016-05-01
Start Page: 239.e1
End Page: 239.e8
Language: English
ACCESSION: WOS:000375026400022
DOI: 10.1016/j.urolonc.2015.12.001
PROVIDER: wos
PMCID: PMC4834237
PUBMED: 26795607
Notes: Article -- Source: Wos
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MSK Authors
  1. Jonathan Coleman
    346 Coleman
  2. Paul Russo
    582 Russo
  3. Guido Dalbagni
    325 Dalbagni
  4. Daniel D. Sjoberg
    234 Sjoberg
  5. Abraham Ari Hakimi
    327 Hakimi
  6. Roy Mano
    52 Mano
  7. Emily Vertosick
    136 Vertosick