Liedberg Fredrik, Hagberg Oskar, Häggström Christel, Aljabery Firas, Gårdmark Truls, Jahnson Staffan, Jerlström Tomas, Ströck Viveka, Söderkvist Karin, Ullén Anders, Holmberg Lars, Bobjer Johannes
Department of Urology Skåne University Hospital Malmö Sweden.
Institution of Translational Medicine Lund University Malmö Sweden.
BJUI Compass. 2025 Sep 22;6(9):e70093. doi: 10.1002/bco2.70093. eCollection 2025 Sep.
To investigate the association between waiting time and outcomes in patients with upper tract urothelial carcinomas (UTUC).
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.
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).
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.
研究上尿路尿路上皮癌（UTUC）患者等待时间与预后之间的关联。
我们在瑞典对膀胱数据库2.0中858例2015 - 2019年接受UTUC根治性手术的基于人群的队列进行了研究。通过多变量Cox回归模型研究诊断等待时间（从转诊到诊断，参考值<1周）、治疗等待时间（从诊断到手术，参考值<5周）和总等待时间（参考值<10周）与疾病特异性生存（DSS）和总生存（OS）的关系。为进一步探讨这些关联，通过逻辑回归评估从术前记录的临床肿瘤分期到切除标本中病理肿瘤分期的分期进展情况。
总等待时间与DSS、OS或分期进展无关。1至4周的诊断等待时间与更好的DSS（风险比[HR]0.57[95%置信区间（CI）0.35 - 0.94]）和OS（HR 0.60[95% CI 0.41 - 0.87]）相关。在肾盂UTUC患者亚组中，诊断等待时间>4周与分期进展相关（比值比[OR]2.44[95% CI 1.00 - 5.95]），在输尿管UTUC患者中，5至10周的治疗等待时间与更差 的DSS相关（HR 2.85（95% CI 1.03 - 7.89）。
总体而言，较短的治疗路径与良好的生存估计相关，但由于优先考虑晚期和/或有明显症状肿瘤患者的短等待时间，一些估计可能受到选择偏倚的影响。等待时间增加导致的分期进展可能表明存在潜在的因果机制。
