Systematic Review of the Incidence of and Risk Factors for Urothelial Cancers and Renal Cell Carcinoma Among Patients with Haematuria

Bhavan Prasad Rai, Jose Luis Dominguez-Escrig, Luís L. Vale, Teele Kuusk, Otakar Čapoun, Viktor Soukup, Harman M.H.M. Bruins, Yuhong Yuan, Philippe P.D. Violette, Nancy Santesso, Bas W.G. van Rhijn, A. Hugh Mostafid, Muhammad Imran Omar

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Context
The current impact of haematuria investigations on health care organisations is significant. There is currently no consensus on how to investigate patients with haematuria.

Objective
To evaluate the incidence of bladder cancer, upper tract urothelial carcinoma (UTUC), and renal cell carcinoma (RCC) among patients undergoing investigation for haematuria and identify any risk factors for bladder cancer, UTUC, and RCC (BUR).

Evidence acquisition
Medline, Embase, and Cochrane controlled trials databases and ClinicalTrials.gov were searched for all relevant publications from January 1, 2000 to June 2021 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Prospective, retrospective, and cross-sectional studies with a minimum population of 50 patients with haematuria were considered for the review.

Evidence synthesis
A total of 44 studies were included. The total number of participants was 229 701. The pooled incidence rate for urothelial bladder cancer was 17% (95% confidence interval [CI] 14–20%) for visible haematuria (VH) and 3.3% (95% CI 2.45–4.3%) for nonvisible haematuria (NVH). The pooled incidence rate for RCC was 2% (95% CI 1–2%) for VH and 0.58% (95% CI 0.42–0.77%) for NVH. The pooled incidence rate for UTUC was 0.75% (95% CI 0.4–1.2%) for VH and 0.17% (95% CI 0.081–0.299%) for NVH. On sensitivity analysis, the proportions of males (risk ratio [RR] 1.14, 95% CI 1.10–1.17 for VH; 1.54, 95% CI 1.34–1.78 for NVH; p < 0.00001; moderate certainty evidence) and individuals with a smoking history (RR 1.41, 95% CI 1.24–1.61 for VH; 1.53, 95% CI 1.36–1.72 for NVH; p < 0.00001; moderate certainty evidence) appeared to be higher in BUR than in non-BUR groups.

Conclusions
Male gender and smoking history are risk factors for BUR cancer in haematuria, with bladder cancer being the commonest cancer. The incidence of RCC and UTUC in NVH is low. The review serves as a reference standard for future policy-making on investigation of haematuria by global organisations.

Patient summary
Our review shows that male gender and smoking history are risk factors for cancers of the bladder, kidney, and ureter. The review also provides information on the proportion of patients who have cancer when they have blood in their urine (haematuria) and will allow policy-makers to decide on the most appropriate method for investigating haematuria in patients.
Original languageEnglish
Number of pages11
JournalEuropean Urology
Early online date5 Apr 2022
DOIs
Publication statusE-pub ahead of print - 5 Apr 2022

Keywords

  • haematuria
  • Urological neoplasms
  • urinary bladder neoplasms
  • Kidney Neoplasms
  • smoking
  • sex
  • Radiotherapy
  • age distribution
  • Transitional cell carcinoma
  • cystoscopy

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