title: A delay in radical nephroureterectomy can lead to upstaging.
abstract: METHODS
  Prognosis (case series).
  
  
  METHODS
  4.
  
  
  OBJECTIVE
  To examine the association between the delay from diagnosis of upper-tract urothelial carcinoma (UTUC) to radical nephroureterectomy (RNU), and the pathological features and outcomes, as the decision to proceed to RNU for an individual patient is complex.
  
  
  METHODS
  The records of 187 patients who had RNU were reviewed; the interval from diagnosis to RNU was analysed as both a continuous (months) and categorical variable (<3 vs > or =3 months). Logistic regression and survival analyses were used to evaluate the association between time from diagnosis to RNU with pathological characteristics and clinical outcomes.
  
  
  RESULTS
  The median time from diagnosis to RNU was 45 days (interquartile range 68). A delay from diagnosis to RNU analysed as a continuous variable was associated with advanced stage, higher grade, previous endoscopic procedure, tumour necrosis, infiltrative tumour architecture, and lymphovascular invasion (P = 0.034), but not disease recurrence or cancer-specific mortality. In the subgroup of patients (90, 48.1%) who had muscle-invasive disease (> or =pT2) a longer delay from diagnosis to RNU as a continuous variable was associated with advanced stage (P = 0.030), higher grade (P = 0.014), infiltrative tumour architecture (P = 0.044), lymphovascular invasion (P = 0.034), disease recurrence (P = 0.02), and cancer-specific mortality (P = 0.03).
  
  
  CONCLUSIONS
  Our data suggest that a delay in the interval from diagnosis to RNU is associated with more advanced disease stage. These findings might have important implications for trial design in the ongoing evaluation of neoadjuvant regimens. Timely consideration of definitive treatment for patients with high-risk UTUC is of high importance. Further studies are necessary to validate these hypothesis-generating findings.
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Waldert
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Marberger
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D013997:Time Factors; D014513:Ureter / Q000601:surgery; D014516:Ureteral Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery