Oncologic impact of delay between diagnosis and radical nephroureterectomy

Kuan-Hsien Wu; Chao-Hsiang Chang; Hsi-Chin Wu; Steven K Huang; Chien-Liang Liu; Cheng-Kuang Yang; Jian-Ri Li; Jen-Shu Tseng; Wun-Rong Lin; Chih-Chin Yu; Chi-Wen Lo; Chao-Yuan Huang; Chung-Hsin Chen; Chung-You Tsai; Pai-Yu Cheng; Yuan-Hong Jiang; Yu-Khun Lee; Yung-Tai Chen; Ting-Chun Yeh; Jen-Tai Lin; Yao-Chou Tsai; Thomas Y Hsueh; Bing-Juin Chiang; Yi-De Chiang; Wei-Yu Lin; Yeong-Chin Jou; See-Tong Pang; Hung-Lung Ke

doi:10.3389/fonc.2022.1025668

Oncologic impact of delay between diagnosis and radical nephroureterectomy

Front Oncol. 2022 Dec 14:12:1025668. doi: 10.3389/fonc.2022.1025668. eCollection 2022.

Authors

Kuan-Hsien Wu¹, Chao-Hsiang Chang^{2

3}, Hsi-Chin Wu^{2

3

4}, Steven K Huang^{5

6

7}, Chien-Liang Liu⁵, Cheng-Kuang Yang⁸, Jian-Ri Li^{8

9}, Jen-Shu Tseng^{10

11

12}, Wun-Rong Lin^{10

11}, Chih-Chin Yu^{13

14}, Chi-Wen Lo¹³, Chao-Yuan Huang¹⁵, Chung-Hsin Chen¹⁵, Chung-You Tsai^{16

17}, Pai-Yu Cheng^{16

18}, Yuan-Hong Jiang¹⁹, Yu-Khun Lee¹⁹, Yung-Tai Chen²⁰, Ting-Chun Yeh²⁰, Jen-Tai Lin²¹, Yao-Chou Tsai^{14

22

23}, Thomas Y Hsueh^{24

25}, Bing-Juin Chiang^{26

27

28}, Yi-De Chiang^{29

30

31}, Wei-Yu Lin^{32

33

34}, Yeong-Chin Jou^{35

36}, See-Tong Pang³⁷, Hung-Lung Ke^{1

38

39

40}

Affiliations

¹ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
² Department of Urology, China Medical University and Hospital, Taichung, Taiwan.
³ School of Medicine, China Medical University, Taichung, Taiwan.
⁴ Department of Urology, China Medical University Beigang Hospital, Yunlin, Taiwan.
⁵ Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
⁶ Department of Medical Science Industries, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan.
⁷ School of medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁸ Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
⁹ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
¹⁰ Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan.
¹¹ Department of Medicine, Mackay Medical College, Taipei, Taiwan.
¹² Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹³ Division of Urology, Department of surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
¹⁴ School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
¹⁵ Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
¹⁶ Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
¹⁷ Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan.
¹⁸ Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
¹⁹ Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
²⁰ Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan.
²¹ Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
²² Department of surgery, Taipei Tzu chi Hospital, The Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
²³ Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
²⁴ Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan.
²⁵ Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
²⁶ College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
²⁷ Department of Urology, Cardinal Tien Hospital, New Taipei City, Taiwan.
²⁸ Department of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan.
²⁹ Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
³⁰ Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
³¹ TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan.
³² Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan.
³³ Chang Gung University of Science and Technology, Chiayi, Taiwan.
³⁴ Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³⁵ Department of Urology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.
³⁶ Department of Health and Nutrition Biotechnology, Asian University, Taichung, Taiwan.
³⁷ Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
³⁸ Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³⁹ Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴⁰ Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.

Abstract

Purpose: This study aimed to evaluate the oncological outcome of delayed surgical wait time from the diagnosis of upper tract urothelial carcinoma (UTUC) to radical nephroureterectomy (RNU).

Methods: In this multicenter retrospective study, medical records were collected between 1988 and 2021 from 18 participating Taiwanese hospitals under the Taiwan UTUC Collaboration Group. Patients were dichotomized into the early (≤90 days) and late (>90 days) surgical wait-time groups. Overall survival, disease-free survival, and bladder recurrence-free survival were calculated using the Kaplan-Meier method and multivariate Cox regression analysis. Multivariate analysis was performed using stepwise linear regression.

Results: Of the 1251 patients, 1181 (94.4%) were classifed into the early surgical wait-time group and 70 (5.6%) into the late surgical wait-time group. The median surgical wait time was 21 days, and the median follow-up was 59.5 months. Our study showed delay-time more than 90 days appeared to be associated with worse overall survival (hazard ratio [HR] 1.974, 95% confidence interval [CI] 1.166-3.343, p = 0.011), and disease-free survival (HR 1.997, 95% CI 1.137-3.507, p = 0.016). This remained as an independent prognostic factor after other confounding factors were adjusted. Age, ECOG performance status, Charlson Comorbidity Index (CCI), surgical margin, tumor location and adjuvant systemic therapy were independent prognostic factors for overall survival. Tumor location and adjuvant systemic therapy were also independent prognostic factors for disease-free survival.

Conclusions: For patients with UTUC undergoing RNU, the surgical wait time should be minimized to less than 90 days. Prolonged delay times may be associated with poor overall and disease-free survival.

Keywords: nephroureterectomy; surgical wait time; survival; ureteroscopy; urinary tract urothelial carcinoma.