title: Delay in nephrectomy and cancer control outcomes in elderly patients with small renal masses.
abstract: OBJECTIVE
  To examine the impact of nephrectomy delay on the survival of patients with small renal masses.
  
  
  METHODS
  Relying on the Surveillance, Epidemiology, and End Results Medicare-linked database, 6,237 patients with pT1a renal cell carcinoma who underwent radical or partial nephrectomy were identified (1988-2005). Nephrectomy delay was dichotomized as ≤3 vs. >3 months. Uni- and multivariate Cox regression analyses tested the effect of delayed nephrectomy on cancer-specific mortality (CSM). In sub-analyses, various other time from diagnosis to nephrectomy cut-offs were modelled: (a) ≤1 vs. >1 month, (b) ≤2 vs. >2 months, (c) ≤4 vs. >4 months, (d) ≤6 vs. >6 months, (e) ≤12 vs. >12 months or (f) continuously coded.
  
  
  RESULTS
  In univariate analyses, nephrectomy delay >3 months was associated with a higher risk of CSM (hazard ratio [HR]: 2.07; 95% confidence interval [CI]: 1.58-2.72; p < 0.001). However, after multivariate adjustment, a nephrectomy delay >3 months was not significantly associated with a higher risk of CSM (HR: 1.33; 95% CI: 0.96-1.86; p = 0.09). The lack of a relationship between nephrectomy delay and CSM after multivariate adjustment persisted even in various sub-analyses of other categorizations for nephrectomy delay.
  
  
  CONCLUSIONS
  In the case of eventual nephrectomy delay among patients with small renal masses, CSM is unaffected.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
authors.forename: Andreas
authors.initials: A
authors.lastname: Becker
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.forename: Praful
authors.initials: P
authors.lastname: Ravi
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.forename: Luis Alexander
authors.initials: LA
authors.lastname: Kluth
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.forename: Roland
authors.initials: R
authors.lastname: Dahlem
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schlomm
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012306:Risk; D018426:SEER Program; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014481:United States