Stratifying Patients with Haematuria into High or Low Risk Groups for Bladder Cancer: a Novel Clinical Scoring System

Abstract

Haematuria is a common presentation of bladder cancer and requires a full urologic evaluation. This study aimed to develop a scoring system capable of stratifying patients with haematuria into high or low risk groups for having bladder cancer to help clinicians decide which patients need more urgent assessment. This crosssectional study included all adult patients referred for haematuria and subsequently undergoing full urological evaluation in the years 2001 to 2011. Risk factors with strong association with bladder cancer in the study population were used to design the scoring system. Accuracy was determined by the area under the receiver operating characteristic (ROC) curve. A total of 325 patients with haematuria were included, out of which 70 gender, a history of cigarette smoking and the presence of gross haematuria. A scoring system using 4 clinical parameters as variables was created. The scores ranged between 6 to 14, and a score of 10 and above indicated high risk for having bladder cancer. It was found to have good accuracy with an area under the ROC curve of in this study has the potential to help clinicians stratify patients who present with haematuria into high or low risk for having bladder cancer. This will enable high-risk patients to undergo urologic assessment earlier.

External Validation of a Clinical Scoring System for Hematuria

“…Tan's scoring system demonstrated adequate discrimination in the first study (area under the ROC curve=80.4%) (Tan et al, 2013). Nevertheless, this model needs to be validated in a secondary dataset.…”

“…In addition, we observed a score of 12 as the best score threshold in our validation cohort. Tan et al (2013) reported that a threshold figure of 10 gives the scoring system a sensitivity of 90% and a specificity of 55.7%. Using the suggested cut-off value of 10 in our cohort, the scoring system had a sensitivity of 86.1% but a specificity of only 36.7%, while the cut-off value of 12 yielded a sensitivity of 69.6% and a specificity of 69.7%.…”

“…The scoring system proposed by Tan et al (Tan et al, 2013) to predict the probability that patients presenting with hematuria had bladder cancer included four clinical parameters: age (≥50=2 vs <50 =1), gender (male=2 vs female=1), history of smoking (smoker/ex-smoker=4 vs non-smoker=2) and nature of the hematuria (gross=6 vs microscopic=2). The total score ranged from 6 to 14.…”

“…Furthermore, as the existing models rely on nuclear matrix protein-22 (NMP22) (Lotan et al, 2009) or immunocytology (Cha et al, 2012a), they are not practical for a daily clinical environment. Recently, Tan et al (2013) developed a new scoring system using four clinical variables (age, gender, smoking status, and nature of the hematuria) to stratify patients with hematuria into high or low risk of having bladder cancer.…”

A segregation index combining phenotypic (clinical characteristics) and genotypic (gene expression) biomarkers from a urine sample to triage out patients presenting with hematuria who have a low probability of urothelial carcinoma

“…Several clinical prognostic characteristics, including age, gender, smoking history and degree of hematuria, are well-established as risk factors for UC in patients with hematuria [ 3 , 20 - 22 ]. Recently, several groups have attempted to develop models based on clinical prognostic characteristics to predict the risk of UC in patients with hematuria [ 20 - 22 ], but critically, these models offer limited accuracy and have largely focused on detecting patients with UC rather than ruling out patients who do not have disease. These detection-focused models have therefore been insufficient to reliably identify patients with disease during a primary evaluation, even if used in combination with urine cytology [ 20 - 22 ].…”