Exploring the diversity and predictors of histopathological findings across the European Association of Urology Guidelines Office rapid reaction group priority groups for patients with renal tumours: Implications for prioritization of renal cancer care

ABSTRACT

Introduction & Objectives: The COVID-19 pandemic has forced disruptive changes in the prioritization of care in Urology worldwide. In response to the first peak of the outbreak, the European Association of Urology (EAU) Guidelines Office Rapid Reaction Group (GORRG) provided comprehensive recommendations to guide the prioritization of surgery for patients with non-metastatic renal cell carcinoma (RCC). Notably, to date, such priority groups have not been validated from a histopathological perspective. To fill this gap, in this study we sought to explore the diversity and predictors of histopathological findings across the EAU GORRG priority groups for renal tumors at a referral Academic Centre. Materials & Methods: After Ethical Committee approval, we queried our prospectively collected Institutional database to select consecutive patients undergoing elective surgery for cT1-4 N0-1 M0 renal masses between January 2017 and December 2020. The primary outcome measures at histopathological analysis were a) benign histology;b) non-organ confined disease (pT3-4 and/or pN1);c) adverse pathologic features for both clear cell RCC (ccRCC) and papillary RCC (pRCC) according to validated prognostic models. Results: Overall, 940 (54.2%), 358 (20.6%) and 436 (25.2%) patients were classified as low-, intermediate- and high-priority, respectively. The three groups significantly differed regarding all primary histopathological outcomes: benign histology (21.6% vs 15.9% vs 6.4% for the low-, intermediate- and high-risk group, respectively, p<0.001);b) non-organ-confined disease (5.0% vs 19.0% vs 45.4%, p<0.001);c) adverse pathologic features according to validated prognostic models (including median Leibovich score for clear cell RCC 0 vs 2 vs 4, p<0.001). At multivariable analysis, beyond the EAU GORRG priority groups, specific patient and/or tumor-related characteristics were independent predictors of the aforementioned histopathological outcomes. s EAU22 – 37th Annual EAU Congress (Figure Presented) Conclusions: To the best of our knowledge, our study showed for the first time the value of the EAU GORRG priority groups from a histopathological standpoint, prompting the implementation of such a prioritization scheme beyond the COVID-19 pandemic.