Impact of Time-To-Surgery and Surgical Delay on Oncologic Outcomes for Renal Cell Carcinoma.

Shiff, Benjamin; Breau, Rodney H; Patel, Premal; Mallick, Ranjeeta; Tanguay, Simon; So, Alan; Lavallée, Luke; Moore, Ron; Rendon, Ricardo; Kapoor, Anil; Pouliot, Frédéric; Finelli, Antonio; Bhindi, Bimal; Lattouf, Jean-Baptiste; Basappa, Naveen; Wood, Lori; Heng, Daniel; Bjarnason, Georg; Drachenberg, Darrel

PURPOSE The time between radiographic identification of a renal tumor and surgery can be concerning for patients and clinicians due to fears of tumor progression while awaiting treatment. This study aimed to evaluate the association between surgical wait time and oncologic outcomes for patients with renal cell carcinoma (RCC). MATERIALS AND METHODS The Canadian Kidney Cancer information system (CKCis) is a multi-institutional prospective cohort initiated in January 2011. Patients with clinical stage T1b or greater RCC diagnosed between January 2011 to December 2019 were included in this analysis. Outcomes of interest were pathologic upstaging, cancer recurrence, cancer-specific survival, and overall survival. Time to recurrence and death were estimated using Kaplan-Meier estimates and associations were determined using cox-proportional hazards models. RESULTS 1,769 patients satisfied the study criteria. Median wait times were 54 days (IQR 29-86) for the overall cohort and 81 days (IQR 49-127) for cT1b tumors (n=1166), 45 days (IQR 27-71) for cT2 tumors (n=672), and 35 days (IQR 18-61) for cT3/4 tumors (n=563 tumors). Adjusting for comorbidity, tumor size, grade, histologic subtype, margin status, and pathologic stage, there was no association between prolonged wait time and cancer recurrence or death. CONCLUSION In the context of current surgeon triaging practices, surgical wait times up to 24 weeks were not associated with adverse oncologic outcomes after 2 years of follow-up.