Delayed nephrectomy has comparable long-term overall survival to immediate nephrectomy for cT1a renal cell carcinoma: A population-based analysis

•We examined long-term overall survival (OS) of patients managed with delayed vs immediate nephrectomy for cT1a renal cancer.•Delaying surgery for >6 months for cT1a renal cancer did not affect overall survival with a median follow-up of 82.5 months.•These findings suggest that a period of observ...

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Published in:Urologic oncology 2020-03, Vol.38 (3), p.74.e13-74.e20
Main Authors: Tan, Wei Shen, Trinh, Quoc-Dien, Hayn, Matthew H., Marchese, Maya, Lipsitz, Stuart R., Nabi, Junaid, Kilbridge, Kerry L, Vale, Justin A., Khoubehi, Bijan, Kibel, Adam S., Sun, Maxine, Chang, Steven L., Sammon, Jesse D.
Format: Article
Language:English
Subjects:
Carcinoma, Renal Cell - mortality
Carcinoma, Renal Cell - pathology
Carcinoma, Renal Cell - surgery
Delay
Female
Humans
Kidney cancer
Kidney Neoplasms - mortality
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Male
Middle Aged
Neoplasm Staging
Nephrectomy
Overall survival
Renal cell carcinoma
Retrospective Studies
Small renal mass
Survival Rate
Time Factors
Time-to-Treatment - statistics & numerical data
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Summary:•We examined long-term overall survival (OS) of patients managed with delayed vs immediate nephrectomy for cT1a renal cancer.•Delaying surgery for >6 months for cT1a renal cancer did not affect overall survival with a median follow-up of 82.5 months.•These findings suggest that a period of observation for >6 months is safe and this may allow identification of renal masses, which will benefit from surgical resection. Early surgical resection remains the recommended treatment option for most small renal mass (≤4 cm). We examined the long-term overall survival (OS) of patients managed with delayed and immediate nephrectomy of cT1a renal cancer. We utilized the National Cancer Database (2005–2010) to identify 14,677 patients (immediate nephrectomy: 14,050 patients vs. late nephrectomy: 627 patients) aged 12 months. Median patient age was 55 years with a median follow-up of 82.5 months. Inverse probability of treatment weighting-adjusted Kaplan-Meier curves suggest no significant difference between treatment arms (immediate nephrectomy [180 days]) (Hazard ratio 0.96; 95% confidence interval 0.73–1.26; P = 0.77). This outcome was consistent between all patients regardless of age (P = 0.48). Sensitivity analysis reports no difference in OS even if nephrectomy was delayed by >12 months (P = 0.60). We report that delayed and immediate nephrectomy for cT1a renal cell carcinoma confers comparable long-term OS. These findings suggest that a period of observation of between 6 and 12 months is safe to allow identification of renal masses, which will benefit from surgical resection.
ISSN:1078-1439
1873-2496
DOI:10.1016/j.urolonc.2019.11.008