KEY TAKEAWAYS
- The DETECT I study evaluated Hematuria Cancer Risk Score (HCRS) as a risk assessment tool to identify pts who need further hematuria investigations.
- A prospective cohort of 3,539 patients was investigated for hematuria across 40 UK hospitals.
- Results showed that up to 15% of pts referred for such investigations can avoid invasive procedures, which can lead to substantial cost savings in healthcare.
The Hematuria Cancer Risk Score (HCRS) was formed after analyzing 3,539 hematuria patients (pts) who underwent hematuria assessment in 40 UK hospitals. The external validation cohort included 500 pts directed to secondary care for hematuria examinations through an accelerated access pathway. The pts considered for this study underwent cystoscopy and upper tract imaging. Cancer detection was confirmed via histology. A preset cut-off was specified for the validation cohort.
In the validation cohort, 471 out of 500 pts were analyzed. Of these, 36 patients were diagnosed with urinary tract cancer (33 [7.0%] bladder cancers, 3 [0.6%] upper tract cancers). Patients with bladder cancer exhibited a higher median HCRS than non-cancer patients (6.118 (IQR: 5.741-6.601) versus 5.265 (IQR: 4.423-6.142) p<0.001). HCRS was specified to have a reasonable discrimination rate, with an AUC of 0.727 (95% CI 0.650–0.804). Applying a cut-off score of 4.015 identified 97% of the tumors (n=35), leading to a 15% reduction in the number of patients (n=72) undergoing investigation, including patients with upper tract tumors (1 RCC, 2 UTUC), but one patient suffering from G1 Ta bladder cancer was missed.
The HCRS is an indispensable tool for identifying pts needing hematuria testing. Reports showed that up to 15% of pts referred for such investigations can avoid invasive procedures, resulting in significant cost savings in healthcare. It can be readily integrated into clinical practice, empowering both patients and physicians to make informed decisions.
Source: https://www.auajournals.org/doi/10.1097/JU.0000000000003315.01
Clinical Trial: https://classic.clinicaltrials.gov/ct2/show/NCT02676180
Tan, Wei Shen; Ahmad, Amar; Nathan, Arjun; Ogunbo, Ayodeji; Gbolahan, Olayinka; Kallam, Neha; Tan, Wei Phin; Cohen, Daniel; Volanis, Dimitrios; Kamat, Ashish; Kelly, John PD29-01 THE HEMATURIA CANCER RISK SCORE: A VALIDATION STUDY DEMONSTRATING REDUCTION IN THE NUMBER NEEDED TO INVESTIGATE WHILE PRESERVING FIDELITY OF CANCER DETECTION, Journal of Urology: April 2023 – Volume 209 – Issue Supplement 4
doi: 10.1097/JU.0000000000003315.01
