Stage Migration in Urological Cancers in Germany during the COVID-19 Pandemic: Fact or Fiction?

Abstract

Introduction: The COVID-19 pandemic interrupted many aspects of health care, including cancer treatment. This study aims to assess the potential impact of the COVID-19 pandemic on tumor stage migration in the three most common urological malignancies.

Methods: Patient and tumor characteristics of patients undergoing inpatient rehabilitation (IR) in one dedicated IR center in 2019 (pre-pandemic) and 2021 (mid-pandemic) were retrospectively evaluated. The study focused on patients after radical prostatectomy (RP) for prostate cancer (PCa), radical cystectomy (RC) for bladder cancer (BCa), or (partial) nephrectomy for kidney cancer (KC).

Results: Overall, 9,039 patients (6,898 (76.3%) after RP, 1,427 (15.8%) after RC, 714 (7.9%) after (partial) nephrectomy) were enrolled. A significant decrease of PCa patients suffering from Gleason sum score ≥8 (17.6% vs. 20.5%, p = 0.005) and lymph node metastases (10.9% vs. 13.0%; p = 0.012) was observed. In BCa and KC patients, tumor stage distribution and abundance of lymph node metastases remained stable, while significantly more BCa patients received neoadjuvant chemotherapy (10.4% vs. 20.2%, p = 0.001). Overall, a significant increase in robot-assisted surgery across all investigated malignancies was detected.

Conclusions: No stage migration could be detected across the three most common urological malignancies during the COVID-19 pandemic. Therapeutic standards remained high, while oncological outcomes remained relatively unchanged.

Keywords: Bladder cancer; COVID-19 pandemic; Kidney cancer; Prostate cancer; Stage migration.