During the peak of the COVID-19 pandemic, several elective surgeries for renal cell carcinoma were delayed, with an unknown impact on outcomes for patients. In a retrospective study, researchers from Rutgers Cancer Institute of New Jersey explored the impact of surgical delays for these patients throughout the United States by utilizing the National Cancer Database to examine outcomes of patients who underwent surgery up to and after 3 months postdiagnosis. These findings were presented by Srivastava et al at the 2021 Genitourinary Cancers Symposium (Abstract 283).
Study Background
COVID-19 completely transformed society and, in many instances, disrupted health-care delivery. In an effort to preserve health-care resources and curb the pandemic’s exponential growth, hospitals deferred nonemergent surgeries. The delayed surgeries included potentially curative surgeries for kidney cancer—partial and radical nephrectomy.
At Rutgers Cancer Institute of New Jersey, surgeries were delayed for 1 to 3 months during the pandemic’s height in New Jersey. Researchers aimed to understand the effect of these surgical delays on patients and their oncologic outcomes.
Based on prior studies, it is often accepted that small renal masses (under 4 cm) can be safely observed for several months. This study focused particularly on larger masses (T1b–T2b), still confined to the kidney. For patients with these tumors, the impact of surgical delay is less understood.
“Delaying surgery up to, and even beyond, 3 months does not significantly increase risk of tumor progression in clinically localized renal cell carcinoma. However, if deciding to delay surgery due to COVID-19, tumor histology, growth kinetics, patient comorbidities, and hospital capacity/resources should be considered.”— Srivastava et al
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Methodology
The research team utilized the National Cancer Database to examine nearly 30,000 patients with larger, localized kidney cancers, and assessed the impact of surgical delay for these patients. They defined surgical delay as time from diagnosis to time of surgery. The oncologic implications of surgical delay in kidney cancer were assessed using two endpoints: pT3a upstaging (local cancer progression) and overall survival.
Patients within each clinical stage were substratified by surgical delay, defined as time from diagnosis to surgery. Surgical delay was categorized as less than 1 month, 1 to 3 months, or more than 3 months. Cutoffs were chosen based on the authors’ clinical experience during the pandemic.
Findings
When assessing pT3a upstaging—the study’s primary endpoint—upstaging rates within clinical stage strata were very similar, regardless of surgical delay. In each clinical stage stratum, surgical delay did not appear to increase the risk of local tumor progression. Similar results were found when assessing overall survival—it did not appear that surgical delay up to 3 months correlated to worse survival, even for patients with large, localized tumors. Thus, the study authors concluded that surgical delay of up to 3 months did not lead to worse oncologic outcomes.
During the ongoing COVID-19 pandemic, many patients with localized renal cell carcinoma likely experienced surgical delay. These data may provide reassurance to patients and providers that delays of up to 3 months likely do not influence cancer outcomes.
The study authors concluded, “Delaying surgery up to, and even beyond, 3 months does not significantly increase risk of tumor progression in clinically localized renal cell carcinoma. However, if deciding to delay surgery due to COVID-19, tumor histology, growth kinetics, patient comorbidities, and hospital capacity/resources should be considered.”
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
