Association of Surgical Delay and Overall Survival in Patients With T2 Renal Masses: Implications for Critical Clinical Decision-making During the COVID-19 Pandemic.

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Tytuł:: Association of Surgical Delay and Overall Survival in Patients With T2 Renal Masses: Implications for Critical Clinical Decision-making During the COVID-19 Pandemic.
Autorzy:: Ginsburg KB; Department of Urology, Wayne State University, Detroit, MI. Electronic address: .
Curtis GL; Department of Urology, Wayne State University, Detroit, MI.
Patel DN; Department of Urology, University of California San Diego, San Diego, CA.
Chen WM; Department of Urology, Wayne State University, Detroit, MI.
Strother MC; Fox Chase Cancer Center, Department of Surgical Oncology, Division of Urology and Urologic Oncology, Philadelphia, PA.
Kutikov A; Fox Chase Cancer Center, Department of Surgical Oncology, Division of Urology and Urologic Oncology, Philadelphia, PA.
Derweesh IH; Department of Urology, University of California San Diego, San Diego, CA.
Cher ML; Department of Urology, Wayne State University, Detroit, MI.
Źródło:: Urology [Urology] 2021 Jan; Vol. 147, pp. 50-56. Date of Electronic Publication: 2020 Sep 20.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Publication: New York : Elsevier Science
Original Publication: Ridgewood, N.J., Professional Medical Services Co.
MeSH Terms:: Clinical Decision-Making*
COVID-19/*prevention & control
Kidney Neoplasms/*mortality
Nephrectomy/*statistics & numerical data
Time-to-Treatment/*statistics & numerical data
Aged ; COVID-19/epidemiology ; COVID-19/transmission ; Communicable Disease Control/standards ; Databases, Factual/statistics & numerical data ; Female ; Humans ; Kaplan-Meier Estimate ; Kidney Neoplasms/pathology ; Kidney Neoplasms/surgery ; Male ; Middle Aged ; Mortality/trends ; Neoplasm Staging ; Nephrectomy/standards ; Nephrectomy/trends ; Pandemics/prevention & control ; Proportional Hazards Models ; Puerto Rico/epidemiology ; Retrospective Studies ; SARS-CoV-2/pathogenicity ; Time Factors ; Time-to-Treatment/trends ; United States/epidemiology
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Entry Date(s):: Date Created: 20200923 Date Completed: 20210112 Latest Revision: 20210112
Update Code:: 20240105
PubMed Central ID:: PMC7502240
DOI:: 10.1016/j.urology.2020.09.010
PMID:: 32966822
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Objective: To test for an association between surgical delay and overall survival (OS) for patients with T2 renal masses. Many health care systems are balancing resources to manage the current COVID-19 pandemic, which may result in surgical delay for patients with large renal masses.
Methods: Using Cox proportional hazard models, we analyzed data from the National Cancer Database for patients undergoing extirpative surgery for clinical T2N0M0 renal masses between 2004 and 2015. Study outcomes were to assess for an association between surgical delay with OS and pathologic stage.
Results: We identified 11,848 patients who underwent extirpative surgery for clinical T2 renal masses. Compared with patients undergoing surgery within 2 months of diagnosis, we found worse OS for patients with a surgical delay of 3-4 months (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.00-1.25) or 5-6 months (HR 1.51, 95% CI 1.19-1.91). Considering only healthy patients with Charlson Comorbidity Index = 0, worse OS was associated with surgical delay of 5-6 months (HR 1.68, 95% CI 1.21-2.34, P= .002) but not 3-4 months (HR 1.08, 95% CI 0.93-1.26, P = 309). Pathologic stage (pT or pN) was not associated with surgical delay.
Conclusion: Prolonged surgical delay (5-6 months) for patients with T2 renal tumors appears to have a negative impact on OS while shorter surgical delay (3-4 months) was not associated with worse OS in healthy patients. The data presented in this study may help patients and providers to weigh the risk of surgical delay versus the risk of iatrogenic SARS-CoV-2 exposure during resurgent waves of the COVID-19 pandemic.
(Copyright © 2020 Elsevier Inc. All rights reserved.)

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