A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond

On behalf of the UroSoMe Collaborators, Jeffrey J. Leow, Wei Shen Tan, Wei Phin Tan, Teck Wei Tan, Vinson Wai-Shun Chan, Kari A. O. Tikkinen, Ashish Kamat, Shomik Sengupta, Maxwell V. Meng, Shahrokh Shariat, Morgan Roupret, Karel Decaestecker, Nikhil Vasdev, Yew Lam Chong, Dmitry Enikeev, Gianluca Giannarini, Vincenzo Ficarra, Jeremy Yuen-Chun Teoh

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Abstract

Purpose: The COVID-19 pandemic has led to competing strains on hospital resources and healthcare personnel. Patients with newly diagnosed invasive urothelial carcinomas of bladder (UCB) upper tract (UTUC) may experience delays to definitive radical cystectomy (RC) or radical nephro-ureterectomy (RNU) respectively. We evaluate the impact of delaying definitive surgery on survival outcomes for invasive UCB and UTUC.

Methods: We searched for all studies investigating delayed urologic cancer surgery in Medline and Embase up to June 2020. A systematic review and meta-analysis was performed. Results: We identified a total of 30 studies with 32,591 patients. Across 13 studies (n = 12,201), a delay from diagnosis of bladder cancer/TURBT to RC was associated with poorer overall survival (HR 1.25, 95% CI: 1.09–1.45, p = 0.002). For patients who underwent neoadjuvant chemotherapy before RC, across the 5 studies (n = 4,316 patients), a delay between neoadjuvant chemotherapy and radical cystectomy was not found to be significantly associated with overall survival (pooled HR 1.37, 95% CI: 0.96–1.94, p = 0.08). For UTUC, 6 studies (n = 4,629) found that delay between diagnosis of UTUC to RNU was associated with poorer overall survival (pooled HR 1.55, 95% CI: 1.19–2.02, p = 0.001) and cancer-specific survival (pooled HR of 2.56, 95% CI: 1.50–4.37, p = 0.001). Limitations included between-study heterogeneity, particularly in the definitions of delay cut-off periods between diagnosis to surgery.

Conclusions: A delay from diagnosis of UCB or UTUC to definitive RC or RNU was associated with poorer survival outcomes. This was not the case for patients who received neoadjuvant chemotherapy.
Original languageEnglish
Article number879774
Number of pages19
JournalFrontiers in Surgery
Volume9
Early online date4 Oct 2022
DOIs
Publication statusPublished - 4 Oct 2022

Keywords

  • Surgery
  • delay in surgery
  • delayed treatment
  • time-to-treatment
  • urinary bladder neoplasms
  • ureteral neoplasms
  • urothelial carcinoma
  • bladder cancer
  • bladder carcinoma

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