Tan, WS;
Ahmad, A;
Feber, A;
Mostafid, H;
Cresswell, J;
Fankhauser, CD;
Waisbrod, S;
... DETECT I trial collaborators; + view all
(2019)
Development and validation of a haematuria cancer risk score to identify patients at risk of harbouring cancer.
Journal of Internal Medicine
, 285
(4)
pp. 436-445.
10.1111/joim.12868.
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Abstract
BACKGROUND: A lack of consensus exists among national guidelines regarding who should be investigated for haematuria. Type of haematuria and age specific thresholds are frequently used to guide referral for investigation of haematuria. OBJECTIVES: To develop and externally validate the haematuria cancer risk score (HCRS) to improve patient selection for investigation of haematuria. 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 visible (VH) and non-visible haematuria (NVH). 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 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. This article is protected by copyright. All rights reserved.
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