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.
This was an international multicentre prospective observational study. We included patients aged 16 and over, 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.
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% CI 22.3-34.1), bladder cancer (n=1951) 24.7% (19.1-30.2), UTUC (n=128) 1.14% (0.77-1.52), renal cancer (n=107) 1.05% (0.80-1.29) and prostate cancer (n=124) 1.75% (1.32-2.18). 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 (2.90-4.15) p<0.0001, male sex 1.30 (1.14-1.50) p<0.001 and smoking 2.70 (2.30-3.18) p<0.001.
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.
BJU international. 2021 May 14 [Epub ahead of print]
Sinan Khadhouri, Kevin M Gallagher, Kenneth R MacKenzie, Taimur T Shah, Chuanyu Gao, Sacha Moore, Eleanor F Zimmermann, Eric Edison, Matthew Jefferies, Arjun Nambiar, Miles P Mannas, Taeweon Lee, Giancarlo Marra, Beatrice Lillaz, Juan Gómez Rivas, Jonathan Olivier, Mark A Assmus, Taha Uçar, Francesco Claps, Matteo Boltri, Tara Burnhope, Nkwam Nkwam, George Tanasescu, Nicholas E Boxall, Alison P Downey, Asim Ahmed Lal, Marta Antón-Juanilla, Holly Clarke, David Hw Lau, Kathryn Gillams, Matthew Crockett, Matthew Nielsen, Yemisi Takwoingi, Naomi Chuchu, John O'Rourke, Graeme MacLennan, John S McGrath, Veeru Kasivisvanathan, IDENTIFY Study group
University of Aberdeen, Health Services Research Unit, Aberdeen, UK., British Urology Researchers in Surgical Training (BURST) Collaborative., Department of Urologic Sciences, University of British Columbia, Vancouver, Canada., Department of Surgical Sciences, Città della Salute e della Scienza, Turin, Italy., SanGiovanni Battista Hospital, Turin, Italy., Department of Urology, La Paz University Hospital, Madrid, Spain., Urology department, Claude Huriez Hospital, CHU Lille, F-59000, Lille, France., Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada., Department of Urology, Istanbul Medeniyet University, Turkey., Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy., University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK., Department of Urology, Queen Alexandra Hospital, Portsmouth, UK., alford Royal NHS Foundation Trust, Salford, UK., Doncaster Royal Infirmary, UK., University of North Carolina Hospitals, Chapel Hill, North Carolina, USA., Department of Urology, Hospital Universitario Cruces, Barakaldo, Spain., Bradford Teaching Hospitals, NHS Foundation Trust, UK., Aberdeen Royal Infirmary, Aberdeen, UK., Great Western Hospitals NHS Foundation Trust, Swindon, UK., Frimley Renal Cancer Centre, Frimley Hospitals NHS Foundation Trust, UK., Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, and NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK., Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK., Health Services Research Unit, University of Aberdeen, Aberdeen, UK., University of Exeter Medical School, Exeter, UK., University College London, Division of Surgery and Interventional Science, UK.