Prolonged Surgical Waiting Time for Radical Nephroureterectomy Is Associated With Worse Survival Outcomes in Patients With Upper Tract Urothelial Carcinoma.

Authors

Yusuke Motoki, Takeshi Sano, Takashi Yoshida, Takahiro Nakamoto, Junichi Ikeda, Ryuichi Yoshida, Makoto Taguchi, Takao Mishima, Hisanori Taniguchi, Masaaki Yanishi, Hidefumi Kinoshita

Published in

Clinical genitourinary cancer. Pages 102670. Sep 15, 2026. Epub Sep 15, 2026.

Abstract

We aimed to identify a candidate cutoff for surgical waiting time from diagnosis of upper tract urothelial carcinoma to radical nephroureterectomy and compare survival outcomes between early and delayed surgery groups.
We retrospectively analyzed 435 patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy without neoadjuvant chemotherapy (June 2004-December 2022). A time-dependent receiver operating characteristic approach was used to identify a candidate cutoff of surgical waiting time, and the patients were categorized into early and delayed surgery groups. Between-group imbalances were adjusted using inverse probability of treatment weighting, and we compared overall survival, cancer-specific survival, and recurrence-free survival. Sensitivity analyses treated waiting time as a continuous variable.
By the receiver operating characteristic analysis, 435 patients were classified into early (<43 days) and delayed (≥43 days) surgery groups, comprising 217 and 218 patients, respectively. After inverse probability of treatment weighting adjustment, overall survival was significantly worse in the delayed surgery group than in the early surgery group (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.02-2.00, P = .039) whereas no significant differences were observed in cancer-specific survival (HR 1.39, 95% CI 0.89-2.17, P = .144) or recurrence-free survival (HR 1.44, 95% CI 0.98-2.12, P = .061). Upstaging from clinical A surgical waiting time of ≥43 days from upper tract urothelial carcinoma diagnosis to radical nephroureterectomy was associated with worse overall survival in the primary dichotomized analysis. However, continuous analyses did not show a consistent linear association. Thus, approximately 6 weeks should be regarded as a hypothesis-generating benchmark rather than a universal threshold.

PMID:
42838823
Bibliographic data and abstract were imported from PubMed on 07 Oct 2026.

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