Oncologic outcomes of surgical delay by interval and tumor size in T1b-T2aN0M0 renal cell carcinoma.

BACKGROUND: Surgical delay is often unavoidable in the management of localized renal cell carcinoma (RCC), but the safe duration for postponing surgery remains unclear, particularly for RCC of varying sizes. METHODS: Patients diagnosed with T1a-T2bN0N0 RCC between 2000 and 2022 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariable Cox proportional hazards models were used to assess the impact of surgical delays of more than 1, more than 2, and more than 3 months on cancer-specific survival (CSS). Subgroup analyses were performed according to tumor size categories (4.0-5.9 cm, 6.0-7.9 cm, and 8.0-10.0 cm) at each surgical delay interval. RESULTS: A total of 39,242 patients were included, with a median follow-up time of 80 months (Interquartile range [IQR], 37-138 months). Surgical delays of more than 1 month did not worsen CSS in patients with tumors 4.0-5.9 cm (adjusted HR = 1.05, 95% CI, 0.93-1.18, p = 0.412), 6.0-7.9 cm (adjusted HR = 1.04, 95% CI, 0.92-1.17, p = 0.512), or 8.0-10.0 cm (adjusted HR = 1.07, 95% CI 0.93-1.23, p = 0.376). Delays of more than 2 months showed no significant CSS difference in tumors 4.0-5.9 cm (adjusted HR = 1.06, 95% CI 0.91-1.21, p = 0.496) or 6.0-7.9 cm (adjusted HR = 1.06, 95% CI 0.90-1.25, p = 0.463), but CSS worsened in tumors sized 8.0-10.0 cm (adjusted HR = 1.29, 95% CI 1.06-1.57, p = 0.012). For delays of more than 3 months, CSS was unaffected in tumors 4.0-5.9 cm (adjusted HR = 1.11, 95% CI 0.92-1.31, p = 0.508), but was worse in tumors 6.0-7.9 cm (adjusted HR = 1.28, 95% CI 1.03-1.66, p = 0.021) and 8.0-10.0 cm (adjusted HR = 1.29, 95% CI 1.09-1.52, p = 0.003). CONCLUSION: Surgical delay was not associated with worse CSS for RCC measuring 4.0-5.9 cm within 3 months. For tumors measuring 6.0-7.9 cm and 8.0-10.0 cm, delays of more than 3 months and more than 2 months, respectively, appeared to be linked with worse CSS. However, due to the retrospective nature and potential residual confounding of this study, these findings should be interpreted with caution. Prospective studies are needed to confirm these findings.