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Time to Partial Nephrectomy Versus Cancer-Specific Mortality in 2 to 4 cm Renal Cell Carcinoma
Maximilian Filzmayer1, Michele Nicolazzini2, Federico Polverino3
1Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada; Department of Urology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.
Introduction:
Longer time to surgical treatment (TTST) may adversely affect cancer-specific mortality (CSM) in 2 to 4 cm localized renal cell carcinoma (RCC) treated with partial nephrectomy (PN). This effect may be more pronounced in younger individuals.
Methods:
Patients were identified within the Surveillance, Epidemiology and End Results database (2004-2021) and stratified according to TTST ≤ 3 versus > 3 months. After propensity score matching (PSM), multivariable competing risks regression (CRR) models were fitted. Several upper age inclusion thresholds were tested.
Results:
TTST > 3 months was recorded in 2409 of 8947 (26.9%) PN patients. Over time, the proportion of PN patients with TTST > 3 months increased from 18.2% to 33.0% (P < .001). After PSM, TTST > 3 months independently predicted higher CSM (hazard ratio [HR] 1.62, 95% CI 1.17-3.15, P = .010) in patients aged ≤ 67 years, but not in older patients. Multivariable models with different upper age inclusion thresholds revealed that TTST > 3 months exerted the strongest effect (HR 2.76, 95% CI 1.03-7.35, P = .043) in youngest individuals (aged ≤ 55 years).
Conclusion:
Increasingly larger proportions of PN patients experienced prolonged TTST (> 3 months). Its adverse effect on CSM applies to individuals aged ≤ 67 years and becomes progressively more important with decreasing age. In consequence, efforts aimed at minimizing TTST should predominantly target young PN candidates.
