Surgical delays were associated with upstaged disease and shorter overall survival (OS) among some patients with renal cell carcinoma (RCC), whereas others were unaffected by these delays, according to the results of a retrospective study presented at the 19th Annual Meeting of the International Kidney Cancer Symposium (IKCS 2020) and published in the journal Urologic Oncology: Seminars and Original Investigations.1,2
The COVID-19 pandemic was the inspiration for the study because in health care, “we [have] had to make different types of choices about how we treat our patients and where we disperse our resources,” Arnav Srivastava, MD, MPH, of Rutgers Cancer Institute of New Jersey, and presenter, said.
Based on their review of the literature, the authors hypothesized that T1a tumors were likely safe to delay and tumors of T3a or higher were not; however, the evidence for delay of T1b to T2b tumors was insufficient. Therefore, the goal of this study was evaluate the risk of pT3a upstaging and the effect on overall survival with delay of T1b and T2b RCC tumors.
OS was significantly shorter among patients with cT1b disease with surgical delays of 1 to 3 months (hazard ratio [HR], 1.13; 95% CI, 1.04-1.22; P <.001) or longer than 3 months (HR, 1.55; 95% CI, 1.40-1.73; P <.001). OS was not affected by surgical delay among patients with cT2a (HR, 1.33; 95% CI, 0.95-1.85; P =.091) or cT2b disease (HR, 0.95; 95% CI, 0.56-1.63; P =.862).
At 3 months or longer, upstaging of disease occurred in 9.1% of cT1b tumors, 24.5% of cT2a tumors, and 35.6% of cT2b tumors. However, there was no association between surgical delay of 1 to 3 months or more than 3 months and upstaging by multivarible analyses.
Based on these data, surgery may be delayed for patients with cT2a or cT2b tumors.
However, given the shorter survival, delay of surgery for patients with cT1b disease should be carefully considered. “For patients with these larger clinically localized masses, a thorough understanding of a tumor’s biology, histology, and patient comorbidities are required when discussing delayed intervention,” Dr Srivastava said.
Editor’s note: This article was updated on 11/7/20.
- Srivastava A, Patel HV, Kim S, et al. Delaying surgery for clinical T1b-T2bN0M0 renal cell carcinoma: oncologic implications in the COVID-19 era and beyond. Presented at: 19th Annual Meeting of the International Kidney Cancer Symposium (IKCS 2020); November 6-7, 2020. Abstract NAS105.
- Srivastava A, Patel HV, Kim S, et al. Delaying surgery for clinical T1b-T2bN0M0 renal cell carcinoma: oncologic implications in the covid-19 era and beyond. Urol Oncol. Published online October 20, 2020. doi:10.1016/j.urolonc.2020.10.012
This article originally appeared on Cancer Therapy Advisor