With the outbreak of COVID-19 infection, several selective studies for renal cell carcinoma, the most common type of renal cancer, were delayed, with unknown effects on patient outcomes.
In a retrospective study, researchers at the Rutgers Cancer Institute in New Jersey examined the impact of surgery delay on these patients across the United States using the National Cancer Database to measure patient outcomes underwent surgery up to and after three months after diagnosis.
The results of the work are presented as a poster presentation at the Symposium of Genitourinary Cancers of the American Society of Clinical Oncology (ASCO) 2021 by author Arnav Srivastava, MD, MPH, Rutgers School of Medicine urology resident Robert Wood Johnson, along with senior author Eric A. Singer, MD, MA, MS, FACS, associate head of Urology and Urologic Oncology and director of the Rutgers Cancer Institute Renal Cancer Program and associate professor of surgery and radiation at Rutgers Robert School of Medicine Wood Johnson. They share more about the work:
Why is this topic important to study?
COVID-19 completely transformed society and disrupted the delivery of health care, in many cases. In an effort to preserve health care facilities and prevent the degenerative growth of the pandemic, hospitals delayed surgeries. The delayed surgeries included potentially curative surgeries for kidney cancer – partial and radical nephrectomy. At the Rutgers Cancer Institute in New Jersey, surgeries were delayed for one to three months at the height of the pandemic in New Jersey.
We wanted to understand the impact of these surgical delays on our patients and their oncologic outcomes. Based on prior studies, it is often accepted that small kidney masses (below 4cm) can be safely observed for several months. Our study was of particular interest in larger masses (T1b-T2b), still limited to the kidneys. For patients with these tumors, the effect of surgical delay is not fully understood.
Tell us about the work and what you and your colleagues found?
To examine our question, we used the National Cancer Database, a major U.S. cancer record. We studied nearly 30,000 patients with larger localized kidney cancers and evaluated the impact of surgical delays for these patients. We defined surgery delay as a time from diagnosis to surgery. The oncologic effects of surgical delay in renal cancer were assessed using two endpoints: increased pT3a (localized cancer progression) and overall survival.
Patients within each clinical stage were underdeveloped with delayed surgery, defined as time from diagnosis to surgery. Surgical delay was classified as less than one month, one to three months, or more than three months. Cutoffs were selected based on the clinical experience of the authors during the pandemic.
When evaluating pT3a elevation, the main endpoint of the study was, elevated levels within each clinical-grade strata were very similar, regardless of surgical delay. At all clinical stages – surgical delay did not appear to increase the risk of local tumor progression. Similar results were found when assessing overall survival – surgery delays of up to three months did not appear to be associated with worse survival, even for patients with large localized tumors. Therefore, we conclude that surgery delay of up to three months does not lead to worse oncologic outcomes.
What are the implications and next steps associated with this work?
During COVID-19 pandemic disease, many patients with localized renal cell carcinoma appear to have had delayed surgery. Our data could provide assurance to patients and providers that delays of up to three months do not affect cancer outcomes. However, any decision to delay or delay surgery must be performed in the context of the patient’s comorbidity status, tumor biology and tumor growth kinetics.
Going forward, we must continue to find new ways to safely care for the kidney cancer population. Moreover, the long-term direct effects of COVID-19 on cancer patients remain an area for positive study. As we continue to collect data, we will better understand the direct and indirect effects of pandemic disease on the oncology care we provide.
Source:
Rutgers Cancer Institute in New Jersey