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Smoking status, history of bladder cancer and previous
abdomino-pelvic radiotherapy or surgery were not predictive of a pathological diagnosis of UTTCC following
abnormal CTU. A history of visible haematuria (OR 4.0
[95%CI 1.5-10.0], p=0.003) and appearance of a solid
tumour on CTU (OR 4.2 [95%CI 1.27-13.6], p=0.018)
were predictive of UTTCC. 67/68 (98.5%) of patients
with both visible haematuria and a solid lesion on CTU
had UTTCC.
Conclusion: FURS is a useful tool in the management of
patients with suspected UTTCC, however it may add
delay into the pathway. Risk stratification may be possible
to allow high-risk patients to proceed directly to NU
although consideration to streamlined pathways including
FURS and/or cytology may also be appropriate.
P1-5 Results of POUT - A phase III
randomised trial of peri-operative
chemotherapy versus surveillance in upper
tract urothelial cancer (UTUC)
Birtle A1, Johnson M2, Kocklebergh R3, Keeley F4, Catto
J5, Bryan R6, Jones R7, Chester J8, Hill M9, Donovan J10,
French A11, Harris C12, Powles T13,
Todd R9, Tregellas L9, Wilson C10, Winterbottom A14,
Lewis R9, Hall E9
1Royal Preston Hospital, United Kingdom, 2Newcastle upon Tyne
Hospitals NHS Trust, United Kingdom, 3University Hospitals
Leicester, United Kingdom, 4North Bristol NHS Trust, United
Kingdom, 5The University of Sheffield, United Kingdom, 6University
of Birmingham, United Kingdom, 7Beatson West of Scotland Cancer
Centre, Glasgow, United Kingdom, 8Cardiff University, Cardiff,
United Kingdom, 9Clinical Trials and Statistics Unit, Institute of
Cancer Research, London, United Kingdom, 10University of Bristol,
United Kingdom, 11Southend University Hospital NHS Foundation
Trust, United Kingdom, 12Consumer Representative, London, United
Kingdom, 13St Barts & The London NHS Trust, United Kingdom,
14Fight Bladder Cancer, Chinnor, United Kingdom

Background: The role of chemotherapy post nephroureterectomy (NU) for UTUC is unclear. POUT
(CRUK/11/027; NCT01993979) addresses whether adjuvant chemotherapy improves disease free survival (DFS)
for patients (pts) with histologically confirmed pT2-T4
N0-3 M0 UTUC.
Methods: Pts (max n=345), d90 days post NU, randomised (1:1) to 4 cycles gemcitabine-cisplatin (gemcitabine-carboplatin if GFR 30-49ml/min) or surveillance.
Primary endpoint was DFS. The trial was powered to
detect a hazard ratio (HR) of 0.65 (i.e. improvement in 3yr
DFS from 40% to 55%; 2-sided alpha 5%, 80% power) with
Peto-Haybittle early stopping rules for efficacy & inefficacy.
Secondary endpoints included toxicity (CTCAE v4), quality of life, metastasis-free (MFS) & overall survival (OS).
Results: 261pts (127 surveillance; 134 chemotherapy)
were randomised between 31/05/2012-10/11/2017, across

Journal of Clinical Urology 11(1S)
57 centres. In Oct 2017, independent trial oversight committees recommended POUT recruitment closed; as data
collected thus far (data snapshot 05/09/2017) met early
stopping rule for efficacy in favour of chemotherapy.
At time of interim analysis, median follow-up was 17.6mths
(IQR 7.5-33.6). Median age 69yrs (range 36-88), 30% pT2,
65% pT3; 91% pN0. Most common grade t3 toxicities for
chemotherapy pts during treatment were neutropenia
29% (0% surveillance) & thrombocytopenia 7% (0%).
47/123 (surveillance) & 29/125 (chemotherapy) DFS
events were reported; unadjusted HR=0.47 (95% CI: 0.29,
0.74) in favour of chemotherapy (log-rank p= 0.0009).
Conclusions: Adjuvant chemotherapy improved DFS in
UTUC. POUT was terminated early because of efficacy
favouring chemotherapy; follow-up for OS continues.
Results of POUT, the largest UTUC randomised trial, support adjuvant chemotherapy as a new standard of care.
P1-6 Who should be investigated for
haematuria? A prospective observational
study of 3556 patients
Tan W1, Feber A1, Sapong R1, Khetrapal P1, Rodney
S1, Williams N1, Brew-Graves C1, Kelly J1, DETECT
investigators
1University College London, London, United Kingdom

Background: Haematuria represents a red flag symptom
associated with urinary tract cancer (UTC) risk. We
determined the incidence of UTC diagnosed following
presentation of haematuria and to determine how many
cases of UTC would be missed if the NICE guidance was
applied.
Methods:
A
prospective
observational
study
(NCT02676180) recruited patients in secondary care for
haematuria investigations in 40 UK hospitals. All patients
had cystoscopy and upper tract imaging. Incidence of UTC
in patients presenting with visible (VH) or nonvisible (NVH)
haematuria, gender and age deciles, bladder cancer histology characteristics and risk classification were determined.
Results: 3556 patients underwent haematuria investigations. The incidence of UTC was 10.0% (bladder cancer:
8.0%, renal parenchymal cancer 1.1%, upper tract TCC:
0.7%). The risk of UTC was significantly higher in VH compared to NVH (13.8% vs 3.1%). Higher age, male gender
and smoking history were independently associated with
UTC diagnosis. NICE recommended age thresholds for
VH and NVH would miss 11 UTC (10 bladder cancers, 1
upper tract TCC representing 3.5% and 3.8% of cases
respectively). 70% of bladder cancers missed were intermediate or high-risk cancer. Risk stratification such as
smoking history was not useful in selecting patients below
the age threshold who will benefit from investigations.
Conclusions: Using the age threshold of t 60 years to
investigate patients presenting with NVH and t 45 years for



Table of Contents for the Digital Edition of JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018

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