Abstract
BackgroundTimely diagnosis of bladder and kidney cancer is key to improving clinical outcomes. Given the challenges of early diagnosis, models incorporating clinical symptoms and signs may be helpful to primary care clinicians when triaging at-risk patients.AimTo identify and compare published models that use clinical signs and symptoms to predict the risk of undiagnosed prevalent bladder or kidney cancer.Design and settingSystematic review.MethodA search identified primary research reporting or validating models predicting the risk of bladder or kidney cancer in MEDLINE and EMBASE. After screening identified studies for inclusion, data were extracted onto a standardised form. The risk models were classified using TRIPOD guidelines and evaluated using the PROBAST assessment tool.ResultsThe search identified 20 661 articles. Twenty studies (29 models) were identified through screening. All the models included haematuria (visible, non-visible, or unspecified), and seven included additional signs and symptoms (such as abdominal pain). The models combined clinical features with other factors (including demographic factors and urinary biomarkers) to predict the risk of undiagnosed prevalent cancer. Several models (n = 13) with good discrimination (area under the receiver operating curve >0.8) were identified; however, only eight had been externally validated. All of the studies had either high or unclear risk of bias.ConclusionModels were identified that could be used in primary care to guide referrals, with potential to identify lower-risk patients with visible haematuria and to stratify individuals who present with non-visible haematuria. However, before application in general practice, external validations in appropriate populations are required.
Highlights
Bladder and kidney cancer are the ninth and 15th most common cancers worldwide, respectively
Models were identified that could be used in primary care to guide referrals, with potential to identify lower-risk patients with visible haematuria and to stratify individuals who present with non-visible haematuria
In the UK, bladder and kidney cancers each account for approximately 3% of new cancer cases, and 5300 and 4500 annual deaths, with their incidence expected to rise.[1,2]
Summary
Bladder and kidney cancer are the ninth and 15th most common cancers worldwide, respectively. The majority of bladder and kidney cancers (75% and 59%, respectively) are diagnosed following a referral from primary care in the UK.[1,2,3] A prolonged primary care interval (from patient presentation to referral) is associated with worse clinical outcomes.[4,5] Currently, in England, median diagnosis time for bladder and kidney cancer — after presentation in primary care with a relevant clinical feature — is 51 and 70 days, respectively, with variation seen by symptom.[6]. Diagnosis of bladder and kidney cancer is key to improving clinical outcomes. Given the challenges of early diagnosis, models incorporating clinical symptoms and signs may be helpful to primary care clinicians when triaging at-risk patients
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