Delay in nephrectomy and cancer control outcomes in elderly patients with small renal masses

Urol Int. 2014;92(4):455-61. doi: 10.1159/000356175. Epub 2014 Feb 28.

Abstract

Objective: To examine the impact of nephrectomy delay on the survival of patients with small renal masses.

Methods: Relying on the Surveillance, Epidemiology, and End Results Medicare-linked database, 6,237 patients with pT1a renal cell carcinoma who underwent radical or partial nephrectomy were identified (1988-2005). Nephrectomy delay was dichotomized as ≤3 vs. >3 months. Uni- and multivariate Cox regression analyses tested the effect of delayed nephrectomy on cancer-specific mortality (CSM). In sub-analyses, various other time from diagnosis to nephrectomy cut-offs were modelled: (a) ≤1 vs. >1 month, (b) ≤2 vs. >2 months, (c) ≤4 vs. >4 months, (d) ≤6 vs. >6 months, (e) ≤12 vs. >12 months or (f) continuously coded.

Results: In univariate analyses, nephrectomy delay >3 months was associated with a higher risk of CSM (hazard ratio [HR]: 2.07; 95% confidence interval [CI]: 1.58-2.72; p < 0.001). However, after multivariate adjustment, a nephrectomy delay >3 months was not significantly associated with a higher risk of CSM (HR: 1.33; 95% CI: 0.96-1.86; p = 0.09). The lack of a relationship between nephrectomy delay and CSM after multivariate adjustment persisted even in various sub-analyses of other categorizations for nephrectomy delay.

Conclusions: In the case of eventual nephrectomy delay among patients with small renal masses, CSM is unaffected.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Renal Cell / surgery*
  • Cohort Studies
  • Female
  • Humans
  • Kidney Neoplasms / epidemiology
  • Kidney Neoplasms / surgery*
  • Male
  • Multivariate Analysis
  • Nephrectomy / methods*
  • Prognosis
  • Proportional Hazards Models
  • Risk
  • SEER Program
  • Time-to-Treatment*
  • Treatment Outcome
  • United States