Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
Aberdeen Royal Infirmary, Aberdeen, UK.
BJU Int. 2021 Oct;128(4):440-450. doi: 10.1111/bju.15483. Epub 2021 Sep 8.
To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation.
This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries.
Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3-34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1-30.2), UTUC (n = 128) 1.14% (95% CI 0.77-1.52), renal cancer (n = 107) 1.05% (95% CI 0.80-1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32-2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03-1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90-4.15; P < 0.001), male sex 1.30 (95% CI 1.14-1.50; P < 0.001), and smoking 2.70 (95% CI 2.30-3.18; P < 0.001).
A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer.
评估因血尿就诊于二级医疗机构的患者中，经现有患者风险标志物和地域差异校正后的当代尿路癌（膀胱癌、上尿路尿路上皮癌[UTUC]和肾癌）的流行率。
这是一项国际性多中心前瞻性观察性研究。我们纳入了年龄≥16 岁、因疑似尿路癌就诊于二级医疗机构的患者。已知或既往有泌尿系统恶性肿瘤的患者被排除在外。我们估计了膀胱癌、UTUC、肾癌和前列腺癌的患病率；按年龄、血尿类型、性别和吸烟状况进行分层。我们使用多变量混合效应逻辑回归来调整癌症患病率，以适应年龄、血尿类型、性别、吸烟、医院和国家的因素。
在评估合格性的 11059 名患者中，有 10896 名来自 26 个国家的 110 家医院。经过调整的总体癌症患病率（n=2257）为 28.2%（95%置信区间[CI] 22.3-34.1），膀胱癌（n=1951）为 24.7%（95% CI 19.1-30.2），UTUC（n=128）为 1.14%（95% CI 0.77-1.52），肾癌（n=107）为 1.05%（95% CI 0.80-1.29），前列腺癌（n=124）为 1.75%（95% CI 1.32-2.18）。模型中所有癌症患者风险标志物的比值比为：年龄 1.04（95% CI 1.03-1.05；P<0.001），肉眼血尿 3.47（95% CI 2.90-4.15；P<0.001），男性 1.30（95% CI 1.14-1.50；P<0.001），吸烟 2.70（95% CI 2.30-3.18；P<0.001）。
需要更好地了解国际人群中的癌症流行率，以便为临床指南提供信息。我们是第一个报告在因血尿就诊于二级医疗机构的国际人群中，经患者风险标志物和地域差异校正后的尿路癌患病率的。膀胱癌是最常见的疾病。肉眼血尿是尿路癌的最强预测因子。
