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

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.

Prolonged Diagnostic Intervals as Marker of Missed Diagnostic Opportunities in Bladder and Kidney Cancer Patients with Alarm Features: A Longitudinal Linked Data Study

“…The updated 2015 NICE guidelines and the 2020 American Urological Association include additional clinical criteria to further risk stratify patients with non-visible haematuria, in order to increase the diagnostic yield of cancer in the referred population [ 11 , 27 ]. Clinical decision aids such as risk prediction tools incorporating multiple biological and patient risk factors may help in situations where diagnostic reasoning is challenging, such as by identifying patients with non-visible haematuria and recurrent UTIs who are at higher risk of bladder cancer [ 28 , 29 ].…”

Quality of the diagnostic process in patients presenting with symptoms suggestive of bladder or kidney cancer: a systematic review

“…For example, guidelines should address cut-offs for degree of NVH that should warrant active reviews after treatments for UTIs; or cut-offs for number of UTIs treated before referral), while also taking into account cost-effectiveness of any follow-up actions. Emerging urine biomarkers and risk prediction tools may also be useful additions to improve diagnostic yield 47 48…”

Assessment of Diagnostic Yield of Cystoscopy and Computed Tomographic Urography for Urinary Tract Cancers in Patients Evaluated for Microhematuria

“… 22 , 26 The hematuria risk score calculator indicated the greatest AUC of 0.835 (95% CI, 0.789-0.880). 45 In comparison, the hematuria risk index calculator had an AUC of 0.809 to 0.833 (95% CIs not reported) and, in 3 cohorts, indicated a discrimination for UTC prevalence of 0.3% to 0.5% in low-risk groups and 10.8% to 11.0% in high-risk groups. No UTUC or KCC was diagnosed in the low-risk groups.…”