Surgery Within 6 Weeks May Be a Useful Benchmark in Upper Tract Urothelial Cancer: Study
Japan: Researchers have found in a cohort study that waiting ≥43 days from diagnosis of upper tract urothelial carcinoma to radical nephroureterectomy was associated with worse overall survival in the primary analysis. However, continuous analyses did not demonstrate a consistent linear relationship. Therefore, approximately 6 weeks should be considered a hypothesis-generating benchmark rather than a universal surgical threshold.
Upper tract urothelial carcinoma (UTUC) is a relatively uncommon malignancy arising in the lining of the renal pelvis and ureter. Radical nephroureterectomy (RNU), involving removal of the kidney, ureter and part of the bladder, is an established surgical treatment for patients with localized high-risk disease. The optimal interval between diagnosis and surgery, however, remains uncertain.
To investigate whether surgical timing could influence outcomes, Yusuke Motoki, Department of Urology and Andrology, Kansai Medical University, Japan, and colleagues retrospectively evaluated 435 patients with UTUC who underwent RNU without neoadjuvant chemotherapy between June 2004 and December 2022.
In the study, published in Clinical Genitourinary Cancer, the researchers used a time-dependent receiver operating characteristic (ROC) analysis to identify a potential waiting-time cutoff. Patients were subsequently divided into an early-surgery group, undergoing RNU within the identified interval, and a delayed-surgery group. Statistical differences between the groups were addressed using inverse probability of treatment weighting, with overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) assessed.
The analysis identified 43 days as the candidate cutoff, resulting in 217 patients undergoing surgery within 43 days and 218 patients waiting 43 days or longer.
After adjustment, the delayed-surgery group had significantly poorer overall survival compared with the early-surgery group:
- Overall survival: Delayed surgery was associated with a higher risk of death (HR 1.43).
- Cancer-specific survival: No statistically significant difference was observed (HR 1.39).
- Recurrence-free survival: The difference also did not reach statistical significance (HR 1.44).
- Tumor upstaging: Progression from clinical
The findings suggest that prolonged waiting before definitive surgery may be associated with poorer survival in patients with UTUC. However, the researchers emphasized that the 43-day threshold should not be interpreted as a fixed treatment deadline.
The study's continuous-variable analyses did not demonstrate a consistent linear relationship between increasing surgical waiting time and survival outcomes. The retrospective design and single-study setting also mean that the findings require confirmation in other patient populations.
Overall, the study identifies approximately six weeks as a potential benchmark for evaluating surgical timing in UTUC, rather than establishing a universal cutoff. External validation and prospective studies are needed to determine whether reducing delays before RNU can improve outcomes.
Reference:
Motoki, Y., Sano, T., Yoshida, T., Nakamoto, T., Ikeda, J., Yoshida, R., Taguchi, M., Mishima, T., Taniguchi, H., Yanishi, M., & Kinoshita, H. (2026). Prolonged Surgical Waiting Time for Radical Nephroureterectomy is Associated with Worse Survival Outcomes in Patients with Upper Tract Urothelial Carcinoma. Clinical Genitourinary Cancer, 102670. https://doi.org/10.1016/j.clgc.2026.102670
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