Delaying Surgery for Clinical T1b-T2bN0M0 Renal Cell ......Oct 22, 2020 · A Srivastava1, HV Patel1, S Kim2, B Shinder1, J Sterling1, AL Tabakin1, CF Polotti1, B Saraiya3, TM Mayer3,

Delaying Surgery for Clinical T1b-T2bN0M0 Renal Cell Carcinoma: Oncologic Implications in the COVID-19 Era and Beyond § The spread of the the 2019 Novel Coronavirus (COVID-19) has disrupted healthcare delivery. § Many non-emergent, but potentially curative, urologic oncology procedures have been delayed. § These delays encompass partial and radical nephrectomies for localized renal cell carcinoma (RCC). § Active surveillance (AS) literature demonstrates that for many cT1a (<4cm) mass, observation is often safe. § For cT1b-2b masses, the effect of surgical delay on oncologic outcomes is understudied. Specific Aims 1. Assess the risk of pT3a up-staging in patients with cT1b-cT2b RCC by clinical stage and surgical delay (<1 month, 1-3 months, >3 months) 2. Assess the impact of surgical delay on overall survival (OS) in patients with cT1b-cT2b RCC by clinical stage and surgical delay Study Population § 29,746 patients with cT1b-cT2b RCC from the National Cancer Database cT1b = 22,719 cT2a = 4,670 cT2b = 2,357 § Patients on AS, receiving ablation, not undergoing surgery, missing staging or histology data were excluded Three Surgical Delay Groups <1 month 1-3 months >3 months Stage-stratified Statistical Analysis § Logistic regression models assessed the impact of surgical delay on pT3a up- staging § Cox proportional hazards models and Kaplan Meier curves assess relative survival by surgical delay § Sensitivity Analysis Performed A Srivastava 1 , HV Patel 1 , S Kim 2 , B Shinder 1 , J Sterling 1 , AL Tabakin 1 , CF Polotti 1 , B Saraiya 3 , TM Mayer 3 , IY Kim 1 , S Ghodoussipour 1 , HD Patel 4 , TL Jang 1 , EA Singer 1 1 Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 2 Division of Biometrics, Rutgers Cancer Institute of New Jersey and Rutgers School of Public Health, New Brunswick, NJ 3 Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 4 Department of Urology, Loyola University Medical Center, Maywood, IL [email protected] @4rnav, @eric_facs Variables HR (95% CI) p-value HR (95% CI) p-value Time to surgery from Diagnosis (months) 1 Ref - Ref - 1-3 1.13 [1.02, 1.24] 0.013 1.13 [1.04, 1.22] <0.001 >3 1.60 [1.41, 1.82] <0.001 1.55 [1.4, 1.73] <0.001 Variables HR (95% CI) p-value HR (95% CI) p-value Time to surgery from Diagnosis (months) 1 Ref - Ref - 1-3 1.25 [1.05, 1.5] 0.013 1.14 [0.95, 1.37] 0.158 >3 1.56 [1.14, 2.13] 0.005 1.33 [0.95, 1.85] 0.091 Variables HR (95% CI) p-value HR (95% CI) p-value Time to surgery from Diagnosis (months) 1 Ref - Ref - 1-3 1.29 [1.01, 1.64] 0.039 1.14 [0.89, 1.47] 0.303 >3 1.24 [0.74, 2.07] 0.416 0.95 [0.56, 1.63] 0.862 RCC = renal cell carcionma; HR = hazard ratio; 95% CI = 95% confidence interval; *Adjusted for age, sex, Charlson-Deyo index, race, insurance, income, education, facility type, facility location, distance to facility, tumor size cT1b Univariable Multivariable* Table 2 - Overall Survival of cT1b - cT2b RCC by Surgical Delay cT2a Univariable Multivariable* cT2b Univariable Multivariable* Variables OR (95% CI) p-value OR (95% CI) p-value Time to surgery from Diagnosis (months) 1 Ref - Ref - 1-3 1.05 [0.95, 1.16] 0.371 0.96 [0.86, 1.07] 0.447 >3 1.06 [0.92, 1.23] 0.422 0.90 [0.77, 1.05] 0.17 Variables OR (95% CI) p-value OR (95% CI) p-value Time to surgery from Diagnosis (months) 1 Ref - Ref - 1-3 1.01 [0.87, 1.16] 0.983 0.93 [0.8, 1.09] 0.379 >3 0.98 [0.75, 1.27] 0.866 0.90 [0.69, 1.19] 0.454 Variables OR (95% CI) p-value OR (95% CI) p-value Time to surgery from Diagnosis (months) 1 Ref - Ref - 1-3 0.83 [0.68, 1.01] 0.066 0.87 [0.7, 1.07] 0.186 >3 0.93 [0.62, 1.42] 0.752 0.96 [0.62, 1.51] 0.873 RCC = renal cell carcinoma; OR = odds ratio; 95% CI = 95% confidence interval; *Adjusted for age, sex, Charlson-Deyo index, race, insurance, income, education, facility type, facility location, distance to facility, histology Univariable Multivariable* cT2b Univariable Multivariable* Table 1 - Up-staging of RCC by Duration of Surgical Delay cT1b Univariable Multivariable* cT2a 96.6% 96.3% 94.0% 93.5% 92.6% 88.3% 83.8% 80.1% 70.9% 65.4% 54.0% 41.8% Log rank p < 0.001 95.9% 94.5% 94.7% 91.2% 89.5% 89.2% 75.5% 71.6% 65.0% Log rank p = 0.070 94.7% 94.4% 96.8% 89.8% 87.3% 90.2% 74.3% 64.2% 69.5% Log rank p = 0.105 Figure 2: Impact of Surgical Delay on Overall Survival by Clinical Stage cT1b cT2a cT2b § Delaying surgery >3 months did not increase risk of pT3a up-staging nor adversely impact OS § Non-clear cell RCCs were less likely to be up-staged § Sensitivity analysis (<1 month, 1-3 months, 3-6 months, and >6 months) demonstrated similar results INTRODUCTION METHODS RESULTS CONCLUSIONS § COVID-19 has resulted in the delay of elective, possibly curative surgeries for RCC § We examined the oncologic impact of surgical delay in cT1b-T2b RCC § Surgical delays up to, and even beyond 3 months do not increase the risk of pT3a up-staging nor compromise overall survival § Triaging surgery for RCC should incorporate patient and tumor characteristics 8.9% 24.9% 33.1% 9.3% 23.8% 30.1% 9.1% 24.5% 35.6% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% cT1b cT2a cT2b Figure 1 - Up-staging Rates by Clinical Stage and Surgical Delay <1 months 1-3 months >3 months

Documents

Delaying Surgery for Clinical T1b-T2bN0M0 Renal Cell ......Oct 22, 2020 · A Srivastava1, HV Patel1, S Kim2, B Shinder1, J Sterling1, AL Tabakin1, CF Polotti1, B Saraiya3, TM Mayer3,