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1.
Urology ; 147: 50-56, 2021 01.
Article in English | MEDLINE | ID: covidwho-779729

ABSTRACT

OBJECTIVE: To test for an association between surgical delay and overall survival (OS) for patients with T2 renal masses. Many health care systems are balancing resources to manage the current COVID-19 pandemic, which may result in surgical delay for patients with large renal masses. METHODS: Using Cox proportional hazard models, we analyzed data from the National Cancer Database for patients undergoing extirpative surgery for clinical T2N0M0 renal masses between 2004 and 2015. Study outcomes were to assess for an association between surgical delay with OS and pathologic stage. RESULTS: We identified 11,848 patients who underwent extirpative surgery for clinical T2 renal masses. Compared with patients undergoing surgery within 2 months of diagnosis, we found worse OS for patients with a surgical delay of 3-4 months (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.00-1.25) or 5-6 months (HR 1.51, 95% CI 1.19-1.91). Considering only healthy patients with Charlson Comorbidity Index = 0, worse OS was associated with surgical delay of 5-6 months (HR 1.68, 95% CI 1.21-2.34, P= .002) but not 3-4 months (HR 1.08, 95% CI 0.93-1.26, P = 309). Pathologic stage (pT or pN) was not associated with surgical delay. CONCLUSION: Prolonged surgical delay (5-6 months) for patients with T2 renal tumors appears to have a negative impact on OS while shorter surgical delay (3-4 months) was not associated with worse OS in healthy patients. The data presented in this study may help patients and providers to weigh the risk of surgical delay versus the risk of iatrogenic SARS-CoV-2 exposure during resurgent waves of the COVID-19 pandemic.


Subject(s)
COVID-19/prevention & control , Clinical Decision-Making , Kidney Neoplasms/mortality , Nephrectomy/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Aged , COVID-19/epidemiology , COVID-19/transmission , Communicable Disease Control/standards , Databases, Factual/statistics & numerical data , Female , Humans , Kaplan-Meier Estimate , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Male , Middle Aged , Mortality/trends , Neoplasm Staging , Nephrectomy/standards , Nephrectomy/trends , Pandemics/prevention & control , Proportional Hazards Models , Puerto Rico/epidemiology , Retrospective Studies , SARS-CoV-2/pathogenicity , Time Factors , Time-to-Treatment/trends , United States/epidemiology
2.
J Urol ; 204(4): 720-725, 2020 10.
Article in English | MEDLINE | ID: covidwho-766913

ABSTRACT

PURPOSE: The 2019 novel Coronavirus (COVID-19) pandemic has forced many health care organizations to divert efforts and resources to emergent patient care, delaying many elective oncologic surgeries. We investigated an association between delay in radical prostatectomy and oncologic outcomes. MATERIALS AND METHODS: This is a retrospective review of men with intermediate and high risk prostate cancer in the National Cancer Database undergoing radical prostatectomy from 2010 to 2016. Immediate radical prostatectomy was defined as radical prostatectomy within 3 months of diagnosis, while delayed radical prostatectomy was analyzed in 3-month intervals up to 12 months. Multivariable logistic regression models were fit to test for associations between levels of delayed radical prostatectomy and outcomes of interest (adverse pathology, upgrading on radical prostatectomy, node positive disease and post-radical prostatectomy secondary treatments) compared with men undergoing immediate radical prostatectomy. RESULTS: We identified 128,062 men with intermediate and high risk prostate cancer treated with radical prostatectomy. After adjustment, we did not appreciate a significant difference in odds of adverse pathology, upgrading, node positive disease or post-radical prostatectomy secondary treatments between men treated with immediate radical prostatectomy and any level of delay up to 12 months. Subgroup analysis of men with Grade Group 4 and 5 prostate cancer did not demonstrate an association between delayed radical prostatectomy and worse oncologic outcomes. CONCLUSIONS: In the National Cancer Database delayed radical prostatectomy was not associated with early adverse oncologic outcomes at radical prostatectomy. These results may provide reassurance to patients and urologists balancing care in the current pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Prostatectomy , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Time-to-Treatment , Aged , COVID-19 , Humans , Logistic Models , Male , Middle Aged , Neoplasm Grading , Neoplasm Staging , Pandemics , Retrospective Studies , Risk Assessment , SARS-CoV-2
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