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Association of Surgical Delay and Overall Survival in Patients With T2 Renal Masses: Implications for Critical Clinical Decision-making During the COVID-19 Pandemic.
Ginsburg, Kevin B; Curtis, Gannon L; Patel, Devin N; Chen, Wen Min; Strother, Marshall C; Kutikov, Alexander; Derweesh, Ithaar H; Cher, Michael L.
  • Ginsburg KB; Department of Urology, Wayne State University, Detroit, MI. Electronic address: keginsbu@med.wayne.edu.
  • Curtis GL; Department of Urology, Wayne State University, Detroit, MI.
  • Patel DN; Department of Urology, University of California San Diego, San Diego, CA.
  • Chen WM; Department of Urology, Wayne State University, Detroit, MI.
  • Strother MC; Fox Chase Cancer Center, Department of Surgical Oncology, Division of Urology and Urologic Oncology, Philadelphia, PA.
  • Kutikov A; Fox Chase Cancer Center, Department of Surgical Oncology, Division of Urology and Urologic Oncology, Philadelphia, PA.
  • Derweesh IH; Department of Urology, University of California San Diego, San Diego, CA.
  • Cher ML; Department of Urology, Wayne State University, Detroit, MI.
Urology ; 147: 50-56, 2021 01.
Article in English | MEDLINE | ID: covidwho-779729
Semantic information from SemMedBD (by NLM)
1. Renal mass PROCESS_OF Patients
Subject
Renal mass
Predicate
PROCESS_OF
Object
Patients
2. Kidney LOCATION_OF Large Mass
Subject
Kidney
Predicate
LOCATION_OF
Object
Large Mass
3. Large Mass PROCESS_OF Patients
Subject
Large Mass
Predicate
PROCESS_OF
Object
Patients
4. Patients LOCATION_OF IMPACT gene
Subject
Patients
Predicate
LOCATION_OF
Object
IMPACT gene
5. Kidney Neoplasm PROCESS_OF Patients
Subject
Kidney Neoplasm
Predicate
PROCESS_OF
Object
Patients
6. Renal mass PROCESS_OF Patients
Subject
Renal mass
Predicate
PROCESS_OF
Object
Patients
7. Kidney LOCATION_OF Large Mass
Subject
Kidney
Predicate
LOCATION_OF
Object
Large Mass
8. Large Mass PROCESS_OF Patients
Subject
Large Mass
Predicate
PROCESS_OF
Object
Patients
9. Patients LOCATION_OF IMPACT gene
Subject
Patients
Predicate
LOCATION_OF
Object
IMPACT gene
10. Kidney Neoplasm PROCESS_OF Patients
Subject
Kidney Neoplasm
Predicate
PROCESS_OF
Object
Patients
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)

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Time-to-Treatment / Clinical Decision-Making / COVID-19 / Kidney Neoplasms / Nephrectomy Subject: Time-to-Treatment / Clinical Decision-Making / COVID-19 / Kidney Neoplasms / Nephrectomy Type of study: Prognostic study / Risk factors Language: English Journal: Urology Clinical aspect: Etiology / Prognosis Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Time-to-Treatment / Clinical Decision-Making / COVID-19 / Kidney Neoplasms / Nephrectomy Subject: Time-to-Treatment / Clinical Decision-Making / COVID-19 / Kidney Neoplasms / Nephrectomy Type of study: Prognostic study / Risk factors Language: English Journal: Urology Clinical aspect: Etiology / Prognosis Year: 2021
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