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. 2019 Apr;285(4):436-445.
doi: 10.1111/joim.12868. Epub 2019 Jan 4.

Development and validation of a haematuria cancer risk score to identify patients at risk of harbouring cancer

Collaborators, Affiliations

Development and validation of a haematuria cancer risk score to identify patients at risk of harbouring cancer

W S Tan et al. J Intern Med. 2019 Apr.

Abstract

Background: A lack of consensus exists amongst national guidelines regarding who should be investigated for haematuria. Type of haematuria and age-specific thresholds are frequently used to guide referral for the investigation of haematuria.

Objectives: To develop and externally validate the haematuria cancer risk score (HCRS) to improve patient selection for the investigation of haematuria.

Methods: Development cohort comprise of 3539 prospectively recruited patients recruited at 40 UK hospitals (DETECT 1; ClinicalTrials.gov: NCT02676180) and validation cohort comprise of 656 Swiss patients. All patients were aged >18 years and referred to hospital for the evaluation of visible and nonvisible haematuria. Sensitivity and specificity of the HCRS in the validation cohort were derived from a cut-off identified from the discovery cohort.

Results: Patient age, gender, type of haematuria and smoking history were used to develop the HCRS. HCRS validation achieves good discrimination (AUC 0.835; 95% CI: 0.789-0.880) and calibration (calibration slope = 1.215) with no significant overfitting (P = 0.151). The HCRS detected 11.4% (n = 8) more cancers which would be missed by UK National Institute for Health and Clinical Excellence guidelines. The American Urological Association guidelines would identify all cancers with a specificity of 12.6% compared to 30.5% achieved by the HCRS. All patients with upper tract cancers would have been identified.

Conclusion: The HCRS offers good discriminatory accuracy which is superior to existing guidelines. The simplicity of the model would facilitate adoption and improve patient and physician decision-making.

Keywords: bladder cancer; detection; haematuria; nomogram; predict; urinary tract cancer.

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Conflict of interest statement

None reported.

Figures

Figure 1
Figure 1
ROC curve of the haematuria cancer risk score. AUC 0.768 (95% CI: 0.741, 0.795) in the development cohort and AUC 0.835 (95% CI: 0.789, 0.880) in the validation cohort. The white square, circle and triangle give 0.972 (95% CI: 0.954, 0.989), 0.951 (95% CI: 0.923, 0.975) and 0.898 (95 %CI: 0.863, 0.930) sensitivity in the development data set with cut‐off values of 4.015, 4.386 and 4.916, respectively. Using the same cut‐off values, the black square, circle and triangle show 0.986 (95% CI: 0.957, 1.000), 0.943 (95% CI: 0.886, 0.986) and 0.857 (95% CI: 0.771, 0.929) sensitivity in the validation data set, respectively.
Figure 2
Figure 2
Estimated probability of bladder cancer by age, type of haematuria and smoking history for male (a) and female (b).

References

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