Abstract

BackgroundA 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.ObjectivesTo develop and externally validate the haematuria cancer risk score (HCRS) to improve patient selection for the investigation of haematuria.MethodsDevelopment 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.ResultsPatient 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.ConclusionThe 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.

Highlights

  • The decision to guide who should have investigations following a presentation of haematuria varies between guidelines [1]

  • The American Urological Association guidelines would identify all cancers with a specificity of 12.6% compared to 30.5% achieved by the haematuria cancer risk score (HCRS)

  • We report the development and external validation of a haematuria cancer risk score (HCRS) for the prediction of cancer to enable both patients and physicians to assess cancer risk following a presentation of haematuria

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Summary

Introduction

The decision to guide who should have investigations following a presentation of haematuria varies between guidelines [1]. Recommendations by the National Institute for Health and Care Excellence (NICE) suggest that patients aged ≥45 years with a 2018 The Authors. Consistent across guidelines is the use of agespecific thresholds to guide referral for the investigation of VH and NVH as increasing age is an established risk factor for bladder cancer. We have previously reported that 3.5% of patients presenting with VH and 1.0% of patients with NVH have a diagnosis of malignancy despite not meeting the age threshold set out in NICE guidance [4]. 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

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