TY - JOUR
T1 - Association of Surgical Delay and Overall Survival in Patients With T2 Renal Masses
T2 - Implications for Critical Clinical Decision-making During the COVID-19 Pandemic
AU - Ginsburg, Kevin B.
AU - Curtis, Gannon L.
AU - Patel, Devin N.
AU - Chen, Wen Min
AU - Strother, Marshall C.
AU - Kutikov, Alexander
AU - Derweesh, Ithaar H.
AU - Cher, Michael L.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/1
Y1 - 2021/1
N2 - 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.
AB - 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.
KW - Aged
KW - COVID-19/epidemiology
KW - Clinical Decision-Making
KW - Communicable Disease Control/standards
KW - Databases, Factual/statistics & numerical data
KW - Female
KW - Humans
KW - Kaplan-Meier Estimate
KW - Kidney Neoplasms/mortality
KW - Male
KW - Middle Aged
KW - Mortality/trends
KW - Neoplasm Staging
KW - Nephrectomy/standards
KW - Pandemics/prevention & control
KW - Proportional Hazards Models
KW - Puerto Rico/epidemiology
KW - Retrospective Studies
KW - SARS-CoV-2/pathogenicity
KW - Time Factors
KW - Time-to-Treatment/statistics & numerical data
KW - United States/epidemiology
UR - http://www.scopus.com/inward/record.url?scp=85091941908&partnerID=8YFLogxK
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=purepublist2023&SrcAuth=WosAPI&KeyUT=WOS:000611143200013&DestLinkType=FullRecord&DestApp=WOS
U2 - 10.1016/j.urology.2020.09.010
DO - 10.1016/j.urology.2020.09.010
M3 - Article
C2 - 32966822
SN - 0090-4295
VL - 147
SP - 50
EP - 56
JO - Urology
JF - Urology
ER -