Department of Urology, Southern California Permanente Medical Group, Los Angeles, CA, USA.
Mayo Clin Proc. 2013 Feb;88(2):129-38. doi: 10.1016/j.mayocp.2012.10.004. Epub 2013 Jan 9.
To identify patients who could safely avoid unnecessary radiation and instrumentation after the detection of microscopic hematuria.
We conducted a prospective cohort study of patients who were referred to urologists and underwent a full evaluation for asymptomatic microscopic hematuria during a 2-year period in an integrated care organization in 3 regions along the West Coast of the United States. A test cohort and validation cohort of patients with hematuria evaluations between January 9, 2009, and August 15, 2011, were identified. Patients were followed passively through their electronic health records for a diagnosis of urothelial or renal cancer. The degree of microscopic hematuria, history of gross hematuria, smoking history, age, race, imaging findings, and cystoscopy findings were evaluated as risk factors for malignant tumors.
The test cohort consisted of 2630 patients, of whom 55 (2.1%) had a neoplasm detected and 50 (1.9%) had a pathologically confirmed urinary tract cancer. Age of 50 years or older and a recent diagnosis of gross hematuria were the strongest predictors of cancer. Male sex was also predictive of cancer, whereas smoking history and 25 or more red blood cells per high-power field on a recent urinalysis were not statistically significant. A Hematuria Risk Index developed from these factors had an area under the receiver operating characteristic curve of 0.809. In the validation cohort of 1784 patients, the Hematuria Risk Index performed comparably (area under the curve = 0.829). Overall, 32% of the population was identified as low risk and 0.2% had a cancer detected; 14% of the population was identified as high risk, of whom 11.1% had a cancer found.
These results suggest that a considerable proportion of patients could avoid extensive evaluations with the use of the Hematuria Risk Index.
确定在检测到显微镜下血尿后能够安全避免不必要的辐射和仪器检查的患者。
我们对在美国西海岸的 3 个地区的综合医疗组织中，在 2 年期间被转诊给泌尿科医生并接受无症状显微镜下血尿全面评估的患者进行了前瞻性队列研究。确定了 2009 年 1 月 9 日至 2011 年 8 月 15 日之间接受血尿评估的血尿评估的测试队列和验证队列患者。通过电子病历对患者进行被动随访，以诊断尿路上皮或肾癌。评估了显微镜下血尿程度、肉眼血尿史、吸烟史、年龄、种族、影像学发现和膀胱镜检查发现等作为恶性肿瘤的危险因素。
测试队列包括 2630 例患者，其中 55 例（2.1%）发现有肿瘤，50 例（1.9%）经病理证实患有尿路癌。50 岁或以上的年龄和近期诊断的肉眼血尿是癌症的最强预测指标。男性也是癌症的预测因素，而吸烟史和最近的尿沉渣检查中每高倍镜视野 25 个以上的红细胞则无统计学意义。从这些因素中得出的血尿风险指数的受试者工作特征曲线下面积为 0.809。在 1784 例验证队列患者中，血尿风险指数的表现相当（曲线下面积=0.829）。总体而言，32%的人群被确定为低危，0.2%的人群发现癌症；14%的人群被确定为高危，其中 11.1%的人群发现癌症。
这些结果表明，相当一部分患者可以使用血尿风险指数避免广泛的评估。
