Wait time to nephrectomy does not affect recurrence

In a retrospective analysis of patients with malignant RCC, those who underwent nephrectomy more than 60 days after initial diagnosis had the same risk of recurrence as those who underwent nephrectomy prior to 60 days, reported first author Phillip Mucksavage, MD, chief urology resident at the University of Pennsylvania, Philadelphia.

Active surveillance for renal tumors is an acceptable option, although long-term survival as a function of waiting time to surgery has only recently been explored. Stec et al found that waiting times as long as 3 months between the initial urology visit and surgery did not affect outcomes in patients undergoing nephrectomy for RCC (J Urol 2008; 179:2152-7).

Differences in tumor size, grade

Included in the retrospective analysis were 601 patients with malignant renal tumors who underwent partial or radical nephrectomy. All patients in this analysis were free of metastatic disease at presentation. The average time to surgery after the radiographic diagnosis was 87.1 days, and the median was 62 days. Ninety percent of the patients underwent surgery within 161 days. The longest follow-up was approximately 1,000 days.

Outcomes were analyzed according to less than 60 days or greater than 60 days from initial urology visit to surgery. Patients who underwent surgery within 60 days had a mean tumor size of 5.7 cm, compared to 3.8 cm among the patients who waited more than 60 days. The group undergoing nephrectomy prior to 60 days also had significantly higher tumor grade.

Younger patients and those with larger tumors had shorter times from radiographic diagnosis to surgery.

Five-year survival was 86.6% among the patients who had surgery within 60 days and 93.5% among those who waited longer than 60 days.

"Waiting times did not influence recurrence-free survival and overall survival when tumor grade and stage were factored in," Dr. Mucksavage said. "Time to surgery was not an independent predictor."

However, tumor size and tumor grade did predict recurrence-free survival on multivariate analysis.

"The million-dollar question is when to pull the trigger, and I don't think anyone really knows the optimal time to treat a renal tumor, whether it's based on the growth of the tumor when you're following it or how the tumor appears on x-ray," he said. "Unlike bladder cancer, in which waiting more than 3 months has a definite and significant impact on recurrence and overall survival, waiting at least 60 days to treat a renal tumor does not impact recurrence-free or overall survival."