MP22-14 RISK OF URINARY TRACT MALIGNANCY IN PATIENTS WITH ASYMPTOMATIC MICROSCOPIC HEMATURIA

You have accessJournal of UrologyBladder Cancer: Detection & Screening1 Apr 2014MP22-14 RISK OF URINARY TRACT MALIGNANCY IN PATIENTS WITH ASYMPTOMATIC MICROSCOPIC HEMATURIA Casey Ng, Jeff Slezak, Howard Jung, Richard Lee, Mark St Lezin, Stephen Lieberman, Howard Landa, Stephen Poon, Albert Mariani, Ann Aspera, Daniel Barocas, Steven Jacobsen, and Ronald Loo Casey NgCasey Ng More articles by this author , Jeff SlezakJeff Slezak More articles by this author , Howard JungHoward Jung More articles by this author , Richard LeeRichard Lee More articles by this author , Mark St LezinMark St Lezin More articles by this author , Stephen LiebermanStephen Lieberman More articles by this author , Howard LandaHoward Landa More articles by this author , Stephen PoonStephen Poon More articles by this author , Albert MarianiAlbert Mariani More articles by this author , Ann AsperaAnn Aspera More articles by this author , Daniel BarocasDaniel Barocas More articles by this author , Steven JacobsenSteven Jacobsen More articles by this author , and Ronald LooRonald Loo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.862AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine the incidence and predictors for urinary tract malignancy (renal, ureteral and bladder) in patients who undergo workup for microscopic hematuria. METHODS We conducted a prospective cohort study of patients undergoing evaluation for asymptomatic microscopic hematuria in an integrated managed care organization in 5 regions across the United States. Patients' accompanying diagnoses and baseline cohort characteristics were determined and identified using the International Classification of Diseases, 9th Edition (ICD-9) and our comprehensive electronic health record system. Bivariate associations were assessed using the chi-square test and logistic regression models. Multivariable logistic regression was used to build a predictive risk model. RESULTS Within a cohort of 7642 patients with microscopic hematuria, a total of 187 (2.4%) were diagnosed with a neoplasm. On multivariate analysis, history of gross hematuria within the last 6 months (OR=5.86), age≥50 years old (OR=4.19), male gender (OR=2.57), 25+ RBC/HPF on urinalysis (OR=2.39) and being a current or former smoker (OR=1.90) were significant predictors of malignancy. A Hematuria Risk Index (0 to 11 points) was developed from these factors, which demonstrated an area under the receiver operating characteristic curve of 0.820. We observed natural breaks in the scores that grouped the patients into low, moderate, and high-risk of cancer with 0 to 4 points, 5 to 8 points, and 9 to 11 points, respectively. 29.3%, 56.3% and 14.5% of the population were classified as low, moderate and high-risk, respectively. Malignancy was found in 0.3%, 1.6% and 10.3% patients from the low, moderate and high-risk groups, respectively. CONCLUSIONS History of gross hematuria within the last 6 months, age>50 years old, male gender, 25+ RBC/HPF on UA and being a current or former smoker are significant predictors for urinary tract malignancy in the setting of microscopic hematuria. Classification of patients into low, moderate and high-risk groups will improve patient counseling and will hopefully reduce the need for invasive endoscopy and ionizing radiation exposure for patients within the low-risk category. Multivariate analysis of predictors for urinary tract malignancy Predictors of urinary tract malignancies Odds Ratio (95% CI) p-value History of gross hematuria in the last 6 months 5.86 (4.27-8.04) < 0.0001 Age 50+ 4.19 (2.19-8.03) < 0.0001 Male gender 2.57 (1.78-3.72) < 0.0001 25+ RBC/HPF on UA 2.39 (1.67-3.41) < 0.0001 Smoker (current or former) 1.90 (1.38-2.63) 0.0001 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e239-e240 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Casey Ng More articles by this author Jeff Slezak More articles by this author Howard Jung More articles by this author Richard Lee More articles by this author Mark St Lezin More articles by this author Stephen Lieberman More articles by this author Howard Landa More articles by this author Stephen Poon More articles by this author Albert Mariani More articles by this author Ann Aspera More articles by this author Daniel Barocas More articles by this author Steven Jacobsen More articles by this author Ronald Loo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...