European Association Of Urology Covid Intermediate Prioritisation Group Is Poorly Predictive Of Pathological High-Risk Among Patients With Renal Tumours

Introduction The purpose of prioritisation is to minimise harm while safeguarding access to health care in times of reduced resources. The EAU Guideline Office Rapid Reaction Group (GORRG) issued priority recommendations during the COVID-19 pandemic. We evaluated if the clinical prioritisation for suspected renal cell carcinoma (RCC) planned for surgery matched final pathological risk. Methods From 23 March 2020 until 10 October 2020, patients with suspected RCC were prioritised according to GORGG recommendations. To increase statistical power, GORGG prioritisation was also retrospectively assigned to pre-lockdown RCC surgical cases. The priority group was assessed according to GORGG guidelines, and postoperative risk was assessed according to 2003 Leibovich scores. We evaluated concordance between GORGG prioritisation and post-operative risk, and if stratification could be further improved by subgrouping of size. Results 351 patients with suspected RCC were prioritised and underwent surgery. The intermediate priority group showed poor concordance, with 25.7% and 16.4% being pathological low and high risk, respectively. The low priority group harboured 14.9% intermediate and 1.06% high risk RCC. Within the EAU intermediate group, 34.2% of cT1b tumours were low risk, and 32.3% of cT2a tumours high risk. Analysing at 1 cm increments, 45.1% of 4-5cm tumours were low risk. Conclusions The recommended prioritisation system can be error prone and should be prudently applied based on the centre’s needs. Particularly amongst the intermediate group, centres with clinical capacity should not defer intervention of cT2a tumours for longer than absolutely necessary and in severely limited resources may consider intermediate priority tumours < 5cm as low priority.