Time to partial nephrectomy vs. cancer-specific mortality in 2–4 cm renal cell carcinoma

Introduction Longer time to surgical treatment (TTST) may adversely affect cancer-specific mortality (CSM) in 2–4 cm localized renal cell carcinoma (RCC) treated with partial nephrectomy (PN). This effect may be more pronounced in younger individuals. Methods Patients were identified within the Surveillance, Epidemiology and End Results database (2004–2021) and stratified according to TTST ≤3 vs. >3 months. After propensity score matching (PSM), multivariable competing risks regression (CRR) models were fitted. Several upper age inclusion thresholds were tested. Results TTST >3 months was recorded in 2,409 of 8,947 (26.9%) PN patients. Over time, the proportion of PN patients with TTST >3 months increased from 18.2 to 33.0% (p<0.001). After PSM, TTST >3 months independently predicted higher CSM (HR 1.62, 95% CI 1.17–3.15, p=0.010) in patients aged ≤67 years, but not in older patients. Multivariable models with different upper age inclusion thresholds revealed that TTST >3 months exerted the strongest effect (HR 2.76, 95% CI 1.03–7.35, p=0.043) in youngest individuals (aged ≤55 years). Conclusions Increasingly larger proportions of PN patients experienced prolonged TTST (>3 months). Its adverse effect on CSM applies to individuals aged ≤67 years and becomes progressively more important with decreasing age. In consequence, efforts aimed at minimizing TTST should predominantly target young PN candidates.