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Accurate risk assessment of patients with asymptomatic hematuria for the presence of bladder cancer

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Abstract

Purpose

Bladder cancer is frequently diagnosed during a workup for hematuria. However, most patients with microscopic hematuria and many with gross hematuria are not appropriately referred to urologists. We hypothesized that in patients presenting with asymptomatic hematuria the risk of having bladder cancer can be predicted with high accuracy. Toward this end, we analyzed risk factors in patients with asymptomatic hematuria and developed a nomogram for the prediction of bladder cancer presence.

Methods

Data from 1,182 consecutive subjects without a history of bladder cancer undergoing initial evaluation for asymptomatic hematuria were collected at three centers. Clinical risk factors including age, gender, smoking status, and degree of hematuria were recorded. All subjects underwent standard workup including voided cytology, upper tract imaging, and cystourethroscopy. Factors associated with the presence of bladder cancer were evaluated by univariable and multivariable logistic regression analyses. The multivariable analysis was used to construct a nomogram. Internal validation was performed using 200 bootstrap samples.

Results

Of the 1,182 subjects who presented with asymptomatic hematuria, 245 (20.7 %) had bladder cancer. Increasing age (OR = 1.03, p < 0.0001), smoking history (OR = 3.72, p < 0.0001), gross hematuria (OR = 1.71, p = 0.002), and positive cytology (OR = 14.71, p < 0.0001) were independent predictors of bladder cancer presence. The multivariable model achieved 83.1 % accuracy for predicting the presence of bladder cancer.

Conclusions

Bladder cancer presence can be predicted with high accuracy in patients who present with asymptomatic hematuria. We developed a nomogram to help optimize referral patterns (i.e., timing and prioritization) of patients with asymptomatic hematuria.

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Acknowledgments

We would like to thank Dr. Madhu Mazumdar for her supervision of the statistical analysis. This research was performed under the auspices of the International Bladder Cancer Network (IBCN). Dr. Paul J. Christos was partially supported by the following grant: Clinical Translational Science Center (CTSC) (UL1-RR024996).

Conflict of interest

The authors certify that they have no actual or potential conflict of interest in relation to this article.

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Authors and Affiliations

  1. Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th St, Starr 900, New York, NY, 10065, USA

    Eugene K. Cha & Shahrokh F. Shariat

  2. Division of Medical Oncology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

  3. Division of Biostatistics and Epidemiology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA

    Paul J. Christos

  4. Department of Urology, EuromedClinic, Fürth, and Urologie24, Nürnberg, Germany

    Lenuta-Ancuta Tirsar & Bernd J. Schmitz-Dräger

  5. Department of Urology, University of Tübingen, Tübingen, Germany

    Lenuta-Ancuta Tirsar, Christian Schwentner, Joerg Hennenlotter & Arnulf Stenzl

  6. Department of Pathology, General Hospital of Bolzano, Bolzano, Italy

    Christine Mian

  7. Department of Urology, General Hospital of Bolzano, Bolzano, Italy

    Thomas Martini & Armin Pycha

Authors
  1. Eugene K. Cha
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  2. Lenuta-Ancuta Tirsar
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  3. Christian Schwentner
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  7. Christine Mian
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  8. Thomas Martini
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  10. Shahrokh F. Shariat
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  11. Bernd J. Schmitz-Dräger
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Corresponding author

Correspondence to Shahrokh F. Shariat.

Additional information

Eugene K. Cha and Lenuta-Ancuta Tirsar contributed equally to this paper.

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Cha, E.K., Tirsar, LA., Schwentner, C. et al. Accurate risk assessment of patients with asymptomatic hematuria for the presence of bladder cancer. World J Urol 30, 847–852 (2012). https://doi.org/10.1007/s00345-012-0979-x

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  • DOI: https://doi.org/10.1007/s00345-012-0979-x

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