JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018 - 76

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Objectives: Prediction of growth, in particular knowing
possibility of aggressive cancer in small renal masses on
active surveillance remains poorly understood. The study
was designed to determine whether serial nephrometry
score measurements could predict possibility of aggressive malignancy (grade of cancer) in patients with small
renal masses (SRMs) opting for active surveillance initially.
Patients and Methods: One hundred sixteen patients
between January 2000 and December 2016 undergoing
partial nephrectomy were analyzed using different
nephrometry scoring systems. Measurement of nephrometry scores (RENAL, PADUA, C-Index) was performed by
two researchers. Amongst the patients opting for partial
nephrectomy, 40 were on active surveillance for at least 12
months (mean 32; 12-60 months) prior to partial nephrectomy. CT scan images of these patients were retrieved and
analysed including comparison with histopathology.
Results: Nephrometry scores measured on serial CT
scan images showed a significant correlation between
change in score and grade of cancer on multivariate analysis (p-value 0.001). Addition of multivariate analysis to
nomogram based on change in size alone improved predictive value of AUC from 0.58 to 0.65.
Conclusions: Change in nephrometry scoring measurements can accurately predict presence of malignancy and
grade of cancer in patients opting for active surveillance.
P9-6 Active surveillance of sporadic renal
masses: experience from a single tertiary
centre
Neves J1,2, Parker J2, Tanabalan C2, Walkden M2,3,
Grant L2, Ramachandran N3, Patki P2, Mumtaz F2,
Aitchison M2, Bex A2, Barod R2, Tran M1,2
1University College London, United Kingdom, 2Royal Free London
NHS Foundation Trust, London, United Kingdom, 3University College
London Hospitals NHS Foundation Trust, United Kingdom

Objective: We report on the natural history of renal
lesions under active surveillance at a tertiary high-volume
referral centre in the UK.
Methods: Retrospective analysis of cases with suspected
renal cell carcinoma (RCC) at diagnosis under active surveillance from 2012 to 2017. Patients with confirmed
hereditary syndromes were excluded.
Results: 286 patients (62.9% male, median age at diagnosis 71 - IQR 18) with 350 lesions were reviewed. Median
lesion size was 24.5mm (IQR 20): 291 (83.1%) under 4cm
(small renal mass, SRM) and 17 (4.6%) above 7cm. 56
lesions were excluded due to lack of follow-up imaging at
date of analysis. Median follow-up was 12 months (IQR
20). Histology was known for 135 lesions (45.9%): 73 were
RCC, 40 oncocytomas, 9 oncocytic, 10 angiomyolipomas,
2 papillary adenomas, and 1 angiofibroma. During followup 156 (53.1%) lesions remained stable, 21 (7.1%) reduced

Journal of Clinical Urology 11(1S)
size and 117 (39.8%) increased in size. Increasing lesions
grew a median of 4mm/year (IQR 6.6). Focusing on SRM,
the median growth was 2.6mm/year (IQR 4.2), and 16
(6.6%) went over the 4cm threshold. 31 (10.8%) patients
changed management after a period of surveillance (17
surgery, 14 percutaneous cryoablation). One patient
developed metastasis (cT1b clear cell RCC on a patient
unfit for intervention). No cancer specific deaths occurred,
but there were 10 non-cancer specific deaths. Study limitations include retrospective nature, lack of central radiological review, and short follow up period.
Conclusions: While our SRM median yearly growth rate is
comparable to previous reports, a higher proportion of
cases breached the 4cm threshold. Notwithstanding, metastasis-free and cancer-specific survival were close to 100%.
P9-7 Staging CT chest is not required in the
diagnostic evaluation of patients with cT1a
renal cell carcinoma
Mains E1, Trail M1, Phipps S1, McNeill A1, Leung S1,
Laird A1
1NHS Lothian University Hospitals, Edinburgh, United Kingdom

Introduction: Approximately 1/3 of patients with renal
cell carcinoma (RCC) have metastates at diagnosis, with
the most common site being pulmonary. As a result the
European Association of Urology recommends staging CT
chest for patients diagnosed with RCC and this has been
adopted as a quality performance indicator in Scottish
Cancer Networks. This may be associated with excess
radiation exposure for some patients. Recent research has
identified clinico-pathological parameters, which are predictive of risk of pulmonary metastases at diagnosis, with
the aim of stratifying the use of CT chest. We aimed to
validate these parameters and determine whether CT
chest could be omitted in patients with cT1a RCC.
Methods: Patients with cT1 RCC diagnosed at a single
institution between January 2012 and December 2016
were identified from a prospectively collected database.
Baseline patient demographics, clinical and pathological
TNM stage and treatment type were collected. Symptoms
and blood results at presentation and follow-up were collected retrospectively.
Results: Of 383 patients diagnosed with cT1 RCC during
the study period, 225 patients had cT1a tumours. 3 (1.3%)
patients had metastatic disease at diagnosis. Only 1(0.4%)
patient had lung metastases, while all 3 had visceral abdominal metastases. All 3 patients were symptomatic of systemic
disease and two had an abnormal full blood count.
Conclusion: Isolated lung metastases are rare in patients
with cT1a RCC. In patients with cT1a RCC without additional predictive indicators, it may be safe to omit staging
CT chest. We have initiated a Scottish national audit to
validate these findings further.

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