Leilei Xia1, Benjamin L Taylor1, Jose E Pulido1, Thomas J Guzzo2. 1. Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2. Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: thomas.guzzo@uphs.upenn.edu.
Abstract
PURPOSE: To evaluate the impact of surgical waiting time (SWT) on the survival outcome in patients with upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: We identified patients with nonmetastatic UTUC who underwent radical nephroureterectomy (RNU) between 2004 and 2013 in the National Cancer Database. The association between SWT and overall survival (OS) was evaluated using Cox proportional hazards regression. SWT was categorized into 6 groups: SWT ≤ 7 days, SWT 8 to 30 days, SWT 31 to 60 days, SWT 61 to 90 days, SWT 91 to 120 days, and SWT 121 to 180 days. Multivariable analyses were adjusted for patient, tumor, and facility-related factors. RESULTS: A total of 3,581 patients were included in the final overall cohort and 2,397 (66.9%) patients had the higher-risk disease (high-grade or ≥pT2). Multivariable Cox regressions showed that patients in the groups of SWT 31 to 60 days, SWT 61 to 90 days, and SWT 91 to 120 days had similar OS compared with patients who had SWT of 8 to 30 days in the overall cohort and higher-risk cohort. Patients with SWT 121 to 180 days had worse OS (HR = 1.61, 95% CI: 1.19-2.19, P = 0.002 in the overall cohort; HR = 1.56, 95% CI: 1.11-2.20, P = 0.010 in the higher-risk cohort). CONCLUSIONS: Increased SWT from diagnosis to RNU appears to be not associated with worse OS within 120 days after the diagnosis of UTUC but SWT>120 days may be associated with worsened survival. These findings might have important implications for trial design in the evaluation of neoadjuvant chemotherapy for UTUC and future clinical practice.
PURPOSE: To evaluate the impact of surgical waiting time (SWT) on the survival outcome in patients with upper tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: We identified patients with nonmetastatic UTUC who underwent radical nephroureterectomy (RNU) between 2004 and 2013 in the National Cancer Database. The association between SWT and overall survival (OS) was evaluated using Cox proportional hazards regression. SWT was categorized into 6 groups: SWT ≤ 7 days, SWT 8 to 30 days, SWT 31 to 60 days, SWT 61 to 90 days, SWT 91 to 120 days, and SWT 121 to 180 days. Multivariable analyses were adjusted for patient, tumor, and facility-related factors. RESULTS: A total of 3,581 patients were included in the final overall cohort and 2,397 (66.9%) patients had the higher-risk disease (high-grade or ≥pT2). Multivariable Cox regressions showed that patients in the groups of SWT 31 to 60 days, SWT 61 to 90 days, and SWT 91 to 120 days had similar OS compared with patients who had SWT of 8 to 30 days in the overall cohort and higher-risk cohort. Patients with SWT 121 to 180 days had worse OS (HR = 1.61, 95% CI: 1.19-2.19, P = 0.002 in the overall cohort; HR = 1.56, 95% CI: 1.11-2.20, P = 0.010 in the higher-risk cohort). CONCLUSIONS: Increased SWT from diagnosis to RNU appears to be not associated with worse OS within 120 days after the diagnosis of UTUC but SWT>120 days may be associated with worsened survival. These findings might have important implications for trial design in the evaluation of neoadjuvant chemotherapy for UTUC and future clinical practice.
Authors: Łukasz Nowak; Wojciech Krajewski; Jan Łaszkiewicz; Bartosz Małkiewicz; Joanna Chorbińska; Francesco Del Giudice; Keiichiro Mori; Marco Moschini; Krzysztof Kaliszewski; Paweł Rajwa; Ekaterina Laukhtina; Shahrokh F Shariat; Tomasz Szydełko Journal: J Clin Med Date: 2022-07-11 Impact factor: 4.964
Authors: Christopher J D Wallis; Giacomo Novara; Laura Marandino; Axel Bex; Ashish M Kamat; R Jeffrey Karnes; Todd M Morgan; Nicolas Mottet; Silke Gillessen; Alberto Bossi; Morgan Roupret; Thomas Powles; Andrea Necchi; James W F Catto; Zachary Klaassen Journal: Eur Urol Date: 2020-05-03 Impact factor: 20.096