Delaying Surgery for Clinical T1b-T2bN0M0 Renal Cell Carcinoma: Oncologic Implications in the COVID-19 Era and Beyond

Srivastava, Arnav; Patel, Hiren V.; Kim, Sinae; Shinder, Brian; Sterling, Joshua; Tabakin, Alexandra L.; Polotti, Charles F.; Saraiya, Biren; Mayer, Tina; Kim, Isaac Y.; Ghodoussipour, Saum; Patel, Hiten D.; Jang, Thomas L.; Singer, Eric A.

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 up-staging and our secondary endpoint was overall survival (OS). MATERIALS AND METHODS: We retrospectively abstracted cT1b-T2bN0M0 RCC patients from the National Cancer Database (NCDB), 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 up-staging risk. Kaplan Meier curves and Cox proportional hazards models assessed OS. RESULTS: 29,746 patients underwent partial or radical nephrectomy. Delaying surgery >3 months after diagnosis did not confer pT3a up-staging 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, non-clear cell RCCs were significantly less likely to be up-staged (p<0.001). A sensitivity analysis, performed for delays of <1, 1-3, 3-6, and >6 months, also showed no increase in up-staging risk. CONCLUSIONS: 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.