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Observational Study
. 2021 Oct;128(4):440-450.
doi: 10.1111/bju.15483. Epub 2021 Sep 8.

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Sinan Khadhouri  1   2   3 , Kevin M Gallagher  3   4 , Kenneth R MacKenzie  3   5 , Taimur T Shah  3   6   7 , Chuanyu Gao  3   8 , Sacha Moore  3   9 , Eleanor F Zimmermann  3   10 , Eric Edison  3   11 , Matthew Jefferies  3   12 , Arjun Nambiar  3   5 , Miles P Mannas  13 , Taeweon Lee  13 , Giancarlo Marra  14   15 , Beatrice Lillaz  16 , Juan Gómez Rivas  17 , Jonathan Olivier  18 , Mark A Assmus  19 , Taha Uçar  20 , Francesco Claps  21 , Matteo Boltri  21 , Tara Burnhope  22 , Nkwam Nkwam  22 , George Tanasescu  23 , Nicholas E Boxall  24 , Alison P Downey  25 , Asim A Lal  26 , Marta Antón-Juanilla  27 , Holly Clarke  28 , David H W Lau  2 , Kathryn Gillams  29 , Matthew Crockett  30 , Matthew Nielsen  26 , Yemisi Takwoingi  31 , Naomi Chuchu  32 , John O'Rourke  32 , Graeme MacLennan  1 , John S McGrath  33   34 , Veeru Kasivisvanathan  3   35   36 ; IDENTIFY Study group
Collaborators, Affiliations
Free article
Observational Study

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Sinan Khadhouri et al. BJU Int. 2021 Oct.
Free article

Abstract

Objective: To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation.

Patients and methods: This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries.

Results: Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3-34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1-30.2), UTUC (n = 128) 1.14% (95% CI 0.77-1.52), renal cancer (n = 107) 1.05% (95% CI 0.80-1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32-2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03-1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90-4.15; P < 0.001), male sex 1.30 (95% CI 1.14-1.50; P < 0.001), and smoking 2.70 (95% CI 2.30-3.18; P < 0.001).

Conclusions: A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer.

Keywords: bladder cancer; cancer prevalence; haematuria; hematuria; prostate cancer; renal cancer; upper tract urothelial cancer; urinary tract cancer.

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References

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