Renal Cell Carcinoma After the COVID-19 Pandemic: Evidence of More Advanced Pathological Presentation from a Romanian Tertiary Center.

Background/Objectives: The COVID-19 pandemic disrupted healthcare systems worldwide, raising concerns about delayed cancer diagnosis and treatment. This study evaluated whether renal cell carcinoma (RCC) diagnosed after the pandemic showed more advanced pathological features at presentation. Methods: This retrospective study included all partial and radical nephrectomy specimens with a histopathological diagnosis of RCC examined between March 2018 and February 2023, stratified into pre-COVID (2018-2020), COVID (2020-2021), and post-COVID (2021-2023) periods. Pathological variables were compared using Pearson's χ2 and Kruskal-Wallis tests; odds ratios with 95% confidence intervals were calculated with Holm-Bonferroni correction, and multivariable logistic regression, adjusting for age, sex, tumor size, residence, and histological subtype, was performed for high pathological stage and vascular invasion. Results: A total of 297 RCC cases were included (121 pre-COVID, 46 COVID, 130 post-COVID). Post-COVID tumors more frequently showed advanced pathological stage (61.5% vs. 41.3% and 34.8%; p < 0.001) and vascular invasion (56.9% vs. 29.8% and 34.8%; p < 0.001) than pre-COVID and COVID tumors. These associations survived Holm-Bonferroni correction, except for the post-COVID vs. COVID vascular invasion comparison. Both associations remained significant, and numerically stronger, after multivariable adjustment (adjusted OR 2.91, 95% CI 1.61-5.25 for stage; adjusted OR 3.80, 95% CI 2.11-6.83 for vascular invasion). WHO/ISUP grade, tumor necrosis, and sarcomatoid/rhabdoid differentiation did not differ significantly among periods. Conclusions: This study demonstrates a temporal association between the post-pandemic period and more advanced RCC at surgery, independent of age, sex, tumor size, residence, and histological subtype. These findings are consistent with, though do not establish, pandemic-related delays in diagnosis and treatment as a contributing factor, underscoring the need for studies incorporating institutional healthcare-utilization and outcome data.