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 Tumors: Implications for Individualized Prioritization of Renal Cancer Care

Riccardo Campi; Riccardo Tellini; Antonio Andrea Grosso; Alessio Pecoraro; Andrea Mari; Maria Rosaria Raspollini; Mauro Gacci; Marco Carini; Sergio Serni; Andrea Minervini

doi:10.1016/j.euros.2021.09.009

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 Tumors: Implications for Individualized Prioritization of Renal Cancer Care

Eur Urol Open Sci. 2021 Oct 28:34:5-9. doi: 10.1016/j.euros.2021.09.009. eCollection 2021 Dec.

Authors

Riccardo Campi^{1

2}, Riccardo Tellini^{1

3}, Antonio Andrea Grosso^{1

3}, Alessio Pecoraro^{1

3}, Andrea Mari^{2

3}, Maria Rosaria Raspollini⁴, Mauro Gacci¹, Marco Carini^{2

3}, Sergio Serni^{1

2}, Andrea Minervini^{2

3}

Affiliations

¹ Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
² Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
³ Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, University of Florence, Careggi Hospital, Florence, Italy.
⁴ Histopathology and Molecular Diagnostics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.

Abstract

In response to the COVID-19 pandemic, the European Association of Urology (EAU) Guidelines Office Rapid Reaction Group (GORRG) defined priority groups to guide the prioritization of surgery for nonmetastatic renal cell carcinoma (RCC). In this study we explored the diversity and predictors of histopathological findings across the EAU GORRG priority groups using a large database of 1734 consecutive patients undergoing elective surgery for nonmetastatic renal masses between 2017 and 2020 at a referral institution. Overall, 940 (54.2%), 358 (20.6%), and 436 (25.2%) patients were classified as low-, intermediate-, and high-priority, respectively. The low-, intermediate-, and high-risk groups significantly differed regarding all primary histopathological outcomes: benign histology (21.6% vs 15.9% vs 6.4%; p < 0.001); non-organ-confined disease (5.0% vs 19.0% vs 45.4%; p < 0.001); and adverse pathological features according to validated prognostic models (including the median Leibovich score for clear-cell RCC: 0 vs 2 vs 4; p < 0.001). On multivariable analysis, beyond the EAU GORRG priority groups, specific patient and/or tumor-related characteristics were independent predictors of the aforementioned histopathological outcomes. To the best of our knowledge, our study shows for the first time the value of the EAU GORRG priority groups from a histopathological standpoint and supports implementation of such a prioritization scheme beyond the COVID-19 pandemic.

Patient summary: During the COVID-19 pandemic, the European Association of Urology designed a scheme to prioritize patients needing surgery for kidney cancer according to their tumor characteristics and symptoms. We used results from our hospital database to test the scheme and found that the priority classification can be used to predict cancer outcomes after surgery. This scheme may be useful in prioritizing kidney cancer surgeries after the COVID-19 pandemic.

Keywords: COVID-19; Histology; Nephrectomy; Prioritization; Renal cancer.