Presentation Authors: Wei Shen Tan*, Amar Ahmad, Andrew Feber, London, United Kingdom, Hugh Mostafid, Surrey, United Kingdom, Jo Cresswell, Middlesbrough, United Kingdom, Christian Fankhauser, Sharon Waisbrod, Thomas Hermanns, Zurich, Switzerland, Peter Sasieni, John Kelly, London, United Kingdom
Introduction: A lack of consensus exists among national guidelines regarding who should be investigated for hematuria. Type of hematuria and age specific thresholds are frequently used to guide referral for investigation of haematuria. We developed and externally validate the hematuria cancer risk score (HCRS) to improve patient selection for investigation of hematuria.
Methods: Development cohort comprise of 3,539 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 gross (GH) and microscopic hematuria (MH). Sensitivity and specificity of the HCRS in the validation cohort was derived from a cut-off identified from the discovery cohort.
Results: Patient age, gender, type of hematuria 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.
Conclusions: 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.
Source of Funding: The Urology Foundation, The Mason Medical Research Trust