Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Tumor Stage Progression in Urological Malignancies: A Comparative Study

Alper Keskin¹¹Enis Mert Mert Yorulmaz^2*Kürşad Dönmez³³Serkan Ozcan²²Osman Köse²Sacit Nuri Gorgel²²Yigit Akin²²

• ¹DENİZLİ DEVLET HASTANESİ, Denizli, Türkiye
• ²Faculty of Medicine, Izmir Katip Celebi University, Izmir, Türkiye
• ³İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, İzmir, Türkiye

To determine whether delays in care during the coronavirus pandemic 2019 were associated with pathological stage progression in urological malignancies by comparing surgical outcomes between pre-pandemic era (PREP) and pandemic-era (POSTP) cohorts.We conducted a retrospective before-and-after cohort study at a tertiary academic center. A total of 368 patients underwent radical surgeries for prostate (n=176), bladder (n=78), kidney (n=78), or testicular (n=36) cancers between April 2019 and March 2022. Patients were grouped into PREP (April 2019-March 2020) and POSTP (April 2020-March 2022) cohorts. Clinical, laboratory, and pathological data were compared using Student's t-test, Mann-B"ç"mlend"rd": Yazı t'p': (Varsayılan) T'mes New Roman B"ç"mlend"rd": İng'l'zce (ABD) B"ç"mlend"rd": İng'l'zce (ABD) B"ç"mlend"rd": İng'l'zce (ABD) B"ç"mlend"rd": İng'l'zce (ABD) Sildi: This study aimed to compare the histopathological 71 outcomes of uro-oncological surgeries performed before and 72 after the COVID-19 pandemic and to assess the impact of 73 changes in healthcare access during the pandemic on tumor 74 stage progression. ¶ 75 B"ç"mlend"rd": Yazı t'p': Kalın Değ'l, İng'l'zce (ABD) B"ç"mlend"rd": Yazı t'p': Kalın Değ'l, İng'l'zce (ABD) Sildi: pandemic-era 76 B"ç"mlend"rd": Yazı t'p': Kalın Değ'l, İng'l'zce (ABD) Whitney U test, Chi-square test, or Fisher's exact test, with p<0.05 considered statistically 77 significant. 78 79 Results 80 81POSTP prostatectomy patients had significantly higher preoperative PSA levels (13.2±16.2 82 vs. 7.7±4.5 ng/mL, p<0.001), greater tumor involvement (17.0% vs. 11.5%, p=0.019), and 83 increased extraprostatic extension (33.7% vs. 11.9%, p=0.006) compared to PREP patients. 84Renal tumors were significantly larger during the pandemic (7.4 cm vs. 6.0 cm, p=0.01), and 85 preoperative hemoglobin levels were lower (11.7 vs. 12.9 g/dL, p<0.001), suggesting more 86 advanced disease. No statistically significant differences were observed in pathological 87 staging for bladder or testicular cancers between the two periods (all p>0.05). 88 89 Conclusion 90 91 COVID-19-related care disruptions were associated with adverse pathological features in 92 prostate and renal cancers. In contrast, bladder and testicular cancers showed no significant 93 stage migration. These findings emphasize the need for resilient cancer care pathways to 94 prevent progression during future healthcare crises.