Waiting time in diagnosis and extirpative surgery and association with survival and stage progression in upper tract urothelial carcinomas

Objectives

To investigate the association between waiting time and outcomes in patients with upper tract urothelial carcinomas (UTUC).

Patients and methods

We studied a population-based cohort of 858 patients in BladderBaSe 2.0 subjected to extirpative surgery for UTUC 2015–2019 in Sweden. Diagnostic waiting time (from referral to diagnosis, reference <1 week), treatment waiting time (from diagnosis to surgery, reference <5 weeks) and total waiting time (reference <10 weeks) were investigated in relation to disease-specific (DSS) and overall survival (OS) by multivariable Cox regression models. To further explore these associations, stage progression from preoperatively recorded clinical tumour stage to pathological tumour stage in the extirpated specimen was assessed by logistic regression.

Results

Total waiting time was not associated with DSS, OS or stage progression. A diagnostic waiting time between 1 and 4 weeks was associated with better DSS (HR 0.57 [95% CI 0.35–0.94]) and OS (HR 0.60 [95% CI 0.41–0.87]). In the strata of patients with UTUC in the renal pelvis, a diagnostic waiting time > 4 weeks was associated with stage progression (OR 2.44 [95% CI 1.00–5.95]), and in patients with UTUC in the ureter, a treatment waiting time between 5 and 10 weeks was associated to worse DSS (HR 2.85 (95% CI 1.03–7.89).

Conclusions

In general, shorter care pathways were linked to beneficial survival estimates, yet some estimates may be influenced by selection bias due to prioritizing short waiting times for patients with advanced and/or overt symptomatic tumours. Stage progression with increased waiting time may indicate an underlying causal mechanism.