Impact of surgical wait time on oncologic outcomes in upper urinary tract urothelial carcinoma

Background and Objectives To assess the effect of surgical wait time on the oncologic outcomes of patients with upper urinary tract urothelial carcinoma (UTUC), particularly in the ureter. Methods Using an optimal surgical wait time cutoff value of 30.5 days, we allocated patients to an early group or a late group. Cancer specific survival (CSS) and local/distant recurrence-free survival (RFS) rates were estimated using the Kaplan-Meier method. Factors influencing CSS and RFS after radical surgery were identified using Cox proportional hazards regression models. Subgroup analysis was performed on ureteral urothelial carcinoma using the same methods. Results Of the 138 UTUC patients, CSS and RFS were not significantly different between the two groups. However, subgroup analysis of the 80 patients with ureteral urothelial carcinoma showed that CSS and RFS were significantly higher in the early subgroup, and multivariate analysis showed that a surgical wait time of >1 month was an independent prognostic factor of CSS and RFS in ureteral urothelial carcinoma (P=0.04 and P<0.001). Conclusions A surgical wait time of >1 month in ureteral urothelial carcinoma was found to be an independent prognostic factor of disease recurrence and cancer-specific mortality. J. Surg. Oncol. 2014; 110:468-475. (c) 2014 Wiley Periodicals, Inc.