title: Impact of diagnostic and treatment delay on survival in patients with renal pelvic and ureteral cancer.
abstract: OBJECTIVE
  To investigate the relationships between diagnostic and treatment delay and tumour stage and survival among patients with malignant tumours in the renal pelvis and ureter.
  
  
  METHODS
  A clinical and histopathological review was performed on 943 patients with a primary malignant tumour in the renal pelvis and ureter. We selected 394 patients who had macrohaematuria as an initial symptom, had no previous history of bladder cancer, had undergone surgery and had adequate follow-up. We performed uni- and multivariate analyses of prognostic factors for disease-specific survival.
  
  
  RESULTS
  The median number of days between the first occurrence of macrohaematuria and surgery was 83.5 days (range 4-1770 days). Patients with advanced tumours had the shortest median delay. Advanced tumour stage, a solid growth pattern and vascular invasion were of prognostic importance for disease-specific survival in the multivariate analysis, but diagnostic and treatment delay were not.
  
  
  CONCLUSIONS
  Although the delay was unacceptably long it still had no impact on survival, probably because macroscopic haematuria is a late symptom, in particular in high-grade tumours. New screening methods for the early detection of cancer and new treatment modalities are needed to improve the poor prognosis in stage pT3-pT4 tumours.
authors.affiliation: Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden. sten.holmang@telia.com
authors.forename: Sten
authors.initials: S
authors.lastname: Holmäng
authors.forename: Sonny L
authors.initials: SL
authors.lastname: Johansson
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D007682:Kidney Pelvis; D008297:Male; D013997:Time Factors; D014516:Ureteral Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy