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The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer – a multicentre observational study
Author(s) -
Khadhouri Sinan,
Gallagher Kevin M.,
MacKenzie Kenneth R.,
Shah Taimur T.,
Gao Chuanyu,
Moore Sacha,
Zimmermann Eleanor F.,
Edison Eric,
Jefferies Matthew,
Nambiar Arjun,
Mannas Miles P.,
Lee Taeweon,
Marra Giancarlo,
Lillaz Beatrice,
Gómez Rivas Juan,
Olivier Jonathan,
Assmus Mark A.,
Uçar Taha,
Claps Francesco,
Boltri Matteo,
Burnhope Tara,
Nkwam Nkwam,
Tanasescu George,
Boxall Nicholas E.,
Downey Alison P.,
Lal Asim A,
AntónJuanilla Marta,
Clarke Holly,
Lau David H. W.,
Gillams Kathryn,
Crockett Matthew,
Nielsen Matthew,
Takwoingi Yemisi,
Chuchu Naomi,
O’Rourke John,
MacLennan Graeme,
McGrath John S.,
Kasivisvanathan Veeru
Publication year - 2021
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.15483
Subject(s) - medicine , odds ratio , cancer , bladder cancer , prostate cancer , confidence interval , urinary system , malignancy , gynecology
Objective 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. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, 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. Results 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% confidence interval [CI] 22.3–34.1), bladder cancer ( n = 1951) 24.7% (95% CI 19.1–30.2), UTUC ( n = 128) 1.14% (95% CI 0.77–1.52), renal cancer ( n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer ( n = 124) 1.75% (95% CI 1.32–2.18). The 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 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions 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.