학술논문
Delaying surgery for clinical T1b-T2bN0M0 renal cell carcinoma: Oncologic implications in the COVID-19 era and beyond.
Document Type
Academic Journal
Author
Srivastava A; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.; Patel HV; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.; Kim S; Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Biometrics Shared Resource, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.; Shinder B; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.; Sterling J; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.; Tabakin AL; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.; Polotti CF; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.; Saraiya B; Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.; Mayer T; Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.; Kim IY; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.; Ghodoussipour S; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.; Patel HD; The James Buchanan Brady Urologic Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Urology, Loyola University Medical Center, Maywood, IL.; Jang TL; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.; Singer EA; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ. Electronic address: eric.singer@rutgers.edu.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 9805460 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2496 (Electronic) Linking ISSN: 10781439 NLM ISO Abbreviation: Urol Oncol Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: During COVID-19, many operating rooms were reserved exclusively for emergent cases. As a result, many elective surgeries for renal cell carcinoma (RCC) were deferred, with an unknown impact on outcomes. Since surveillance is commonplace for small renal masses, we focused on larger, organ-confined RCCs. Our primary endpoint was pT3a upstaging and our secondary endpoint was overall survival.
Materials and Methods: We retrospectively abstracted cT1b-T2bN0M0 RCC patients from the National Cancer Database, stratifying them by clinical stage and time from diagnosis to surgery. We selected only those patients who underwent surgery. Patients were grouped by having surgery within 1 month, 1-3 months, or >3 months after diagnosis. Logistic regression models measured pT3a upstaging risk. Kaplan Meier curves and Cox proportional hazards models assessed overall survival.
Results: A total of 29,746 patients underwent partial or radical nephrectomy. Delaying surgery >3 months after diagnosis did not confer pT3a upstaging risk among cT1b (OR = 0.90; 95% CI: 0.77-1.05, P = 0.170), cT2a (OR = 0.90; 95% CI: 0.69-1.19, P = 0.454), or cT2b (OR = 0.96; 95% CI: 0.62-1.51, P = 0.873). In all clinical stage strata, nonclear cell RCCs were significantly less likely to be upstaged (P <0.001). A sensitivity analysis, performed for delays of <1, 1-3, 3-6, and >6 months, also showed no increase in upstaging risk.
Conclusion: Delaying surgery up to, and even beyond, 3 months does not significantly increase risk of tumor progression in clinically localized RCC. However, if deciding to delay surgery due to COVID-19, tumor histology, growth kinetics, patient comorbidities, and hospital capacity/resources, should be considered.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Materials and Methods: We retrospectively abstracted cT1b-T2bN0M0 RCC patients from the National Cancer Database, stratifying them by clinical stage and time from diagnosis to surgery. We selected only those patients who underwent surgery. Patients were grouped by having surgery within 1 month, 1-3 months, or >3 months after diagnosis. Logistic regression models measured pT3a upstaging risk. Kaplan Meier curves and Cox proportional hazards models assessed overall survival.
Results: A total of 29,746 patients underwent partial or radical nephrectomy. Delaying surgery >3 months after diagnosis did not confer pT3a upstaging risk among cT1b (OR = 0.90; 95% CI: 0.77-1.05, P = 0.170), cT2a (OR = 0.90; 95% CI: 0.69-1.19, P = 0.454), or cT2b (OR = 0.96; 95% CI: 0.62-1.51, P = 0.873). In all clinical stage strata, nonclear cell RCCs were significantly less likely to be upstaged (P <0.001). A sensitivity analysis, performed for delays of <1, 1-3, 3-6, and >6 months, also showed no increase in upstaging risk.
Conclusion: Delaying surgery up to, and even beyond, 3 months does not significantly increase risk of tumor progression in clinically localized RCC. However, if deciding to delay surgery due to COVID-19, tumor histology, growth kinetics, patient comorbidities, and hospital capacity/resources, should be considered.
(Copyright © 2020 Elsevier Inc. All rights reserved.)