Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Urology, SCPMG Research and Evaluation, Kaiser Permanente, Pasadena, California.
J Urol. 2021 May;205(5):1387-1393. doi: 10.1097/JU.0000000000001550. Epub 2020 Dec 24.
Microhematuria is a prevalent condition and the American Urological Association has developed a new risk-stratified approach for the evaluation of patients with microhematuria. Our objective was to provide the first evaluation of this important guideline.
This multinational cohort study combines contemporary patients from 5 clinical trials and 2 prospective registries who underwent urological evaluation for hematuria. Patients were stratified into American Urological Association risk strata (low, intermediate or high risk) based on sex, age, degree of hematuria, and smoking history. The primary end point was the incidence of bladder cancer within each risk stratum.
A total of 15,779 patients were included in the analysis. Overall, 727 patients (4.6%) were classified as low risk, 1,863 patients (11.8%) were classified as intermediate risk, and 13,189 patients (83.6%) were classified as high risk. The predominance of high risk patients was consistent across all cohorts. A total of 857 bladder cancers were diagnosed with a bladder cancer incidence of 5.4%. Bladder cancer was more prevalent in men, smokers, older patients and patients with gross hematuria. The cancer incidence for low, intermediate and high risk groups was 0.4% (3 patients), 1.0% (18 patients) and 6.3% (836 patients), respectively.
The new risk stratification system separates hematuria patients into clinically meaningful categories with differing likelihoods of bladder cancer that would justify evaluating the low, intermediate and high risk groups with incremental intensity. Furthermore, it provides the relative incidence of bladder cancer in each risk group which should facilitate patient counseling regarding the risks and benefits of evaluation for bladder cancer.
镜下血尿较为常见，美国泌尿外科学会（AUA）已针对镜下血尿患者制定了一种新的风险分层评估方法。本研究旨在对该重要指南进行首次评估。
本多国队列研究纳入了 5 项临床试验和 2 项前瞻性队列研究中因血尿而接受泌尿科评估的当代患者。根据性别、年龄、血尿程度和吸烟史，将患者分层为 AUA 风险分层（低危、中危或高危）。主要终点为各风险分层中的膀胱癌发生率。
共纳入 15779 例患者。总体而言，727 例（4.6%）患者被归类为低危，1863 例（11.8%）患者被归类为中危，13189 例（83.6%）患者被归类为高危。各队列中高危患者均占主导地位。共诊断出 857 例膀胱癌，膀胱癌发生率为 5.4%。男性、吸烟者、老年患者和肉眼血尿患者膀胱癌更为常见。低危、中危和高危组的癌症发生率分别为 0.4%（3 例）、1.0%（18 例）和 6.3%（836 例）。
新的风险分层系统将血尿患者分为具有不同膀胱癌发生可能性的有临床意义的类别，这将证明对低危、中危和高危组进行递进式评估是合理的。此外，它还提供了各风险组中膀胱癌的相对发生率，这有助于患者就膀胱癌评估的风险和获益进行咨询。
