Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
UCL Cancer Institute, London, UK.
Eur Urol. 2018 Jul;74(1):10-14. doi: 10.1016/j.eururo.2018.03.008. Epub 2018 Apr 10.
There remains a lack of consensus among guideline relating to which patients require investigation for haematuria. We determined the incidence of urinary tract cancer in a prospective observational study of 3556 patients referred for investigation of haematuria across 40 hospitals between March 2016 and June 2017 (DETECT 1; ClinicalTrials.gov: NCT02676180) and the appropriateness of age at presentation in cases with visible (VH) and nonvisible (NVH) haematuria. The overall incidence of urinary tract cancer was 10.0% (bladder cancer 8.0%, renal parenchymal cancer 1.0%, upper tract transitional cell carcinoma 0.7%, and prostate cancer 0.3%). Patients with VH were more likely to have a diagnosis of urinary tract cancer compared with NVH patients (13.8% vs 3.1%). Older patients, male gender, and smoking history were independently associated with urinary tract cancer diagnosis. Of bladder cancers diagnosed following NVH, 59.4% were high-risk cancers, with 31.3% being muscle invasive. The incidence of cancer in VH patients <45 yr of age was 3.5% (n=7) and 1.0% (n=4) in NVH patients <60 yr old. Our results suggest that patients with VH should be investigated regardless of age. Although the risk of urinary tract cancer in NVH patients is low, clinically significant cancers are detected below the age threshold for referral for investigation.
This study highlights the requirement to investigate all patients with visible blood in the urine and an age threshold of ≥60 yr, as recommended in some guidelines, as the investigation of nonvisible blood in the urine will miss a significant number of urinary tract cancers. Patient preference is important, and evidence that patients are willing to submit to investigation should be considered in reaching a consensus recommendation for the investigation of haematuria. International consensus to guide that patients will benefit from investigation should be developed.
目前,指南对于哪些血尿患者需要进行检查仍缺乏共识。
我们在 2016 年 3 月至 2017 年 6 月期间,对 40 家医院因血尿就诊的 3556 例患者进行了一项前瞻性观察性研究(DETECT 1;ClinicalTrials.gov:NCT02676180),以确定尿路上皮癌的发病率,并评估有肉眼血尿(VH)和非肉眼血尿(NVH)的患者的就诊年龄是否恰当。
尿路上皮癌的总发病率为 10.0%(膀胱癌 8.0%,肾实质癌 1.0%,上尿路上皮癌 0.7%,前列腺癌 0.3%)。与 NVH 患者相比,VH 患者更有可能被诊断为尿路上皮癌(13.8% vs. 3.1%)。老年、男性和吸烟史与尿路上皮癌的诊断独立相关。在诊断为 NVH 后发现的膀胱癌中,59.4%为高危癌症,其中 31.3%为肌层浸润性膀胱癌。VH 患者中<45 岁的癌症发病率为 3.5%(n=7),NVH 患者中<60 岁的发病率为 1.0%(n=4)。
无论年龄大小,所有 VH 患者均应接受检查。尽管 NVH 患者的尿路上皮癌风险较低,但<推荐年龄阈值的 NVH 患者的临床显著癌症的检出率较低。
本研究强调了需要根据一些指南建议,对所有有 VH 的患者和≥60 岁的患者进行检查,因为对 NVH 的检查将遗漏大量尿路上皮癌。患者的偏好很重要,在达成血尿检查的共识推荐时,应考虑到患者愿意接受检查的证据。应该制定国际共识来指导哪些患者将受益于检查。