Surgical waiting times and all-cause mortality in patients with non-metastatic renal cell carcinoma

Abstract

Objective

To examine the association between surgical waiting times (SWTs) and all-cause mortality (ACM) in non-metastatic patients with RCC, in relation to tumour stage.

Patients and methods

This nation-wide population-based cohort study included 9,918 M0 RCC patients registered in the National Swedish Kidney Cancer Register, between 2009 and 2021, followed-up for ACM until 9 December 2021, and having measured SWTs. The associations between primarily SWTs from date of radiological diagnosis to date of surgery (WRS) and secondarily SWTs from date of radiological diagnosis to date of treatment decision (WRT) and date of treatment decision to date of surgery (WTS), in relation to ACM, were analysed using Cox regression analysis, adjusted for clinical and demographic characteristics, stratified and unstratified according to T-stage.

Results

During a mean follow-up time of 5 years (49,873 person-years), 23% (n = 2291) of the patients died. The adjusted hazard ratio (AHR) for WRS (months) for all patients was 1.03 (95% confidence interval [CI] = 1.02–1.04; p < 0.001). When subdividing WRS on T-stage, the AHRs were 1.03 (95% CI = 1.01–1.04; p < 0.001) and 1.05 (95% CI = 1.02–1.08; p = 0.003) for stages T1 and T3, respectively, while non-significant for T2 (p = 0.079) and T4 (p = 0.807). Similar results were obtained for WRT and WTS.

Conclusions

Prolonged SWTs significantly increased the risk of early overall death among patients with RCC. The increased risk of early death from any cause show the importance of shortening SWTs in clinical work of patients with this malignant disease.

Keywords:

• all-cause mortality
• renal cancer carcinoma
• kidney cancer
• nephrectomy
• nephron sparing surgery
• overall survival
• renal surgery
• surgical waiting time
• radiofrequency ablation
• cryoablation
• time-to-surgery
• T-stage

Supplementary data

Results for the confounding variables from the Cox regression analyses of waiting times as predictors of ACM as well as results for sensitivity analyses are given in Supplementary Tables S1–S6.

Acknowledgements

Thanks to the members of the NSKCR steering committee and collaborators at the Regional Cancer Centre, Stockholm for providing data from the NSKCR. The NSKCR is supported by unconditional grants from the Swedish Association of Local Authorities and Regions (SALAR).