- Design
- Retrospective registry analysis with propensity matching
- Population
- 16,322 patients with pT1b–2 N0M0 renal cell carcinoma, SEER 2004 to 2021
- Primary outcome
- Cancer-specific mortality by time to surgery
- Effect
- 5-year CSM 7.6% (>3 months) vs 5.9% (≤3 months); adjusted 1.3-fold, P = 0.02
A US registry analysis used SEER data from 2004 to 2021 on 16,322 patients with pT1b–2, node-negative, non-metastatic renal cell carcinoma treated by partial or radical nephrectomy. Published in BJU International on 29 September 2026.
Eighteen per cent waited more than three months from diagnosis to surgery. After propensity matching, five-year cancer-specific mortality was 7.6% with a wait over three months and 5.9% with three months or less. In competing-risks regression, the longer wait was associated with 1.3-fold higher cancer-specific mortality, rising to about 1.6-fold beyond six months. The association held across grades but was not seen in non-clear-cell tumours.
This is registry data, so the reasons for delay are unknown and unmeasured differences may remain. Patients who waited were older and less often pT2, which would if anything bias against finding harm. The finding supports prioritising surgery for larger clear-cell tumours, and it is relevant wherever theatre waiting lists are long.
- Aim to operate on pT1b–2 renal masses within three months of diagnosis where possible
- Prioritise larger clear-cell tumours on waiting lists
- Document reasons for any delay beyond three months
- Reassess imaging if surgery is delayed beyond six months
Why it matters
It puts a number on the cost of a long waiting list for kidney cancer surgery.
Don't overread it
A registry association; it cannot show the delay itself caused the excess deaths.
The statistics, in plain English
A rise from 5.9% to 7.6% is about 1.7 more cancer deaths per 100 patients over five years. The 1.3-fold figure is a relative increase after adjustment for other factors.
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