Incidence and Risk Factors for Urothelial Cancers and Renal Cell Carcinoma in Patients with Hematuria

9 Jun, 22

Introduction

Hematuria is a common symptom in patients with bladder cancer, upper tract urothelial carcinoma (UTUC) and renal cell carcinoma (RCC). The common investigations for patients presenting with hematuria are cystoscopy, upper tract imaging, and sometimes urine cytology and novel urinary biomarkers, leading to a significant impact of investigations on health care organizations. Currently there is lack of consensus on how to investigate patients with hematuria.

Aim

This review analyses the incidence of bladder cancer, UTUC, and RCC among patients undergoing investigation for hematuria and identifies any risk factors for bladder cancer, UTUC, and RCC (BUR).

Method

Study Design

Systematic review and meta-analysis of prospective, retrospective and cross-sectional studies.

Treatment Strategy

Medline, Embase, and Cochrane databases were extensively searched for all relevant publications from January 1, 2000 to June 2021 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach.
The review included prospective, retrospective, and cross-sectional studies with a minimum population of 50 patients with hematuria.

Endpoints

Primary Endpoint

Incidence of BUR among patients with visible hematuria (VH) and nonvisible hematuria (NVH)

Secondary Endpoints

Risk factors for BUR in patients with hematuria

Results

The meta-analysis comprised 44 studies with 229701 participants.
The pooled incidence rate for BUR in VH and NVH is seen in Figure 1.

Figure 1. Pooled incidence rate for BUR

The findings of the sensitivity analysis revealed that, the proportions of males (risk ratio [RR] 1.14 for VH; RR 1.54 for NVH; p < 0.00001) and individuals with a smoking history (RR 1.41 for VH; RR 1.53 for NVH; p < 0.00001) were higher in BUR than in non-BUR groups.

Conclusion

In patients presenting with hematuria, male gender and smoking history are risk factors for bladder cancer, renal cell carcinoma (RCC) and upper tract urothelial cancer (UTUC), bladder cancer being the most common among the three.
The incidence of RCC and UTUC in patients with nonvisible hematuria (NVH) was extremely low.
This review will be beneficial to the global organizations in designing policies for appropriate investigation of hematuria.

Eur Urol. 2022 Apr 5; S0302-2838(22)01798-5. Doi: 10.1016/j.eururo.2022.03.027.