Development and validation of a haematuria cancer risk score to identify patients at risk of harbouring cancer
BAUS ePoster online library. Tan W. Jun 24, 2019; 259506; P2-2
Dr. Wei Shen Tan
Dr. Wei Shen Tan
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Abstract
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BACKGROUND

A lack of consensus exists among national guidelines regarding who should be investigated for haematuria. Current guidelines utalise type of haematuria and age specific thresholds to guide referral for investigation of haematuria. We reported the development and external validation of 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.
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