The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer – a multicentre observational study

IDENTIFY Study group

doi:10.1111/bju.15483

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer – a multicentre observational study

IDENTIFY Study group

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39 Scopus citations

Abstract

Objective: 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. Patients and Methods: 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. Results: 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). Conclusions: 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.

Original language	English
Pages (from-to)	440-450
Number of pages	11
Journal	BJU international
Volume	128
Issue number	4
DOIs	https://doi.org/10.1111/bju.15483
State	Published - Oct 2021

Keywords

bladder cancer
cancer prevalence
haematuria
hematuria
prostate cancer
renal cancer
upper tract urothelial cancer
urinary tract cancer

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10.1111/bju.15483

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@article{3b0b083dd972458fa9ba4d5e98340543,

title = "The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer – a multicentre observational study",

abstract = "Objective: 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. Patients and Methods: 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. Results: 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). Conclusions: 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.",

keywords = "bladder cancer, cancer prevalence, haematuria, hematuria, prostate cancer, renal cancer, upper tract urothelial cancer, urinary tract cancer",

author = "{IDENTIFY Study group} and Sinan Khadhouri and Gallagher, {Kevin M.} and MacKenzie, {Kenneth R.} and Shah, {Taimur T.} and Chuanyu Gao and Sacha Moore and Zimmermann, {Eleanor F.} and Eric Edison and Matthew Jefferies and Arjun Nambiar and Mannas, {Miles P.} and Taeweon Lee and Giancarlo Marra and Beatrice Lillaz and {G{\'o}mez Rivas}, Juan and Jonathan Olivier and Assmus, {Mark A.} and Taha U{\c c}ar and Francesco Claps and Matteo Boltri and Tara Burnhope and Nkwam Nkwam and George Tanasescu and Boxall, {Nicholas E.} and Downey, {Alison P.} and Lal, {Asim A.} and Marta Ant{\'o}n-Juanilla and Holly Clarke and Lau, {David H.W.} and Kathryn Gillams and Matthew Crockett and Matthew Nielsen and Yemisi Takwoingi and Naomi Chuchu and John O{\textquoteright}Rourke and Graeme MacLennan and McGrath, {John S.} and Veeru Kasivisvanathan and Aasem Chaudry and Abhishek Sharma and Adam Bennett and Adnan Ahmad and Ahmed Abroaf and Suliman, {Ahmed M.} and Aimee Lloyd and Alastair McKay and Albert Wong and Alberto Silva and Alexandre Schneider and Alison MacKay and Allen Knight and Alkiviadis Grigorakis and Amar Bdesha and Amy Nagle and Ana Cebola and Dhanasekaran, {Ananda Kumar} and Andra{\v z} Kond{\v z}a and Andr{\'e} Barcelos and Galosi, {Andrea B.} and Andrea Ebur and Andrea Minervini and Andrew Russell and Andrew Webb and {Garc{\'i}a de Jal{\'o}n}, {\'A}ngel and Ankit Desai and Czech, {Anna K.} and Anna Mainwaring and Anthony Adimonye and Arighno Das and Arnaldo Figueiredo and Arnauld Villers and Artur Leminski and Arvinda Chippagiri and Asıf Yıldırım and Voulgaris, {Athanasios M.} and Audrey Uzan and Oo, {Aye Moh Moh} and Ayman Younis and Bachar Zelhof and Bashir Mukhtar and Ben Ayres and Ben Challacombe and Benedict Sherwood and Benjamin Ristau and Billy Lai and Brechtje Nellensteijn and Brielle Schreiter and Carlo Trombetta and Catherine Dowling and Catherine Hobbs and Benitez, {Cayo Augusto Estigarribia} and C{\'e}dric Lebacle and Ho, {Cherrie Wing Yin} and Ng, {Chi Fai} and Chloe Mount and Lam, {Chon Meng} and Chris Blick and Christian Brown and Christopher Gallegos and Claire Higgs and Cl{\'i}odhna Browne and Conor McCann and Alonso, {Cristina Plaza} and Daniel Beder and Daniel Cohen and Daniel Gordon and Daniel Wilby and Danny Gordon and Lau, {David Hua Wu} and David Hrouda and D{\'a}vid Karsza and David Mak and David Martin-Way and Denula Suthaharan and Dhruv Patel and Carrion, {Diego M.} and Donald Nyanhongo and Edward Bass and Edward Mains and Edwin Chau and Castillo, {Elba Canelon} and Elizabeth Day and Elsayed Desouky and Emily Gaines and Emma Papworth and Emrah Yuruk and Enes Kilic and Eoin Dinneen and Erika Palagonia and Evanguelos Xylinas and Faizan Khawaja and Fernando Cimarra and Florian Bardet and Francesca Kum and Francesca Peters and G{\'a}bor Kov{\'a}cs and Geroge Tanasescu and Giles Hellawell and Giovanni Tasso and Gitte Lam and {La Montagna}, Giuseppe and Giuseppe Pizzuto and Gordan Lenart and Graeme MacLennan and G{\"u}nal {\"O}zg{\"u}r and Hai Bi and Hannah Lyons and Hannah Warren and Hashim Ahmed and Helen Simpson and Helena Burden and Helena Gresty and Pita, {Hernado Rios} and Holly Clarke and Hosam Serag and Howard Kynaston and Hugh Crawford-Smith and Hugh Mostafid and Hugo Otaola-Arca and {Fen Koo}, Hui and Ibrahim Ibrahim and Idir Ouzaid and Ignacio Puche-Sanz and Igor Toma{\v s}kovi{\'c} and Ilker Tinay and Iqbal Sahibzada and Isaac Thangasamy and Cadena, {Iv{\'a}n Revelo} and Jacques Irani and Jakub Udzik and James Brittain and James Catto and James Green and James Tweedle and Hernando, {Jamie Borrego} and Jamie Leask and Jas Kalsi and Jason Frankel and Jason Toniolo and Raman, {Jay D.} and Jean Courcier and Jeevan Kumaradeevan and Jennifer Clark and Jennifer Jones and Teoh, {Jeremy Yuen Chun} and John Iacovou and John Kelly and Selph, {John P.} and Jonathan Aning and Jon Deeks and Jonathan Olivier and Jonny Maw and Herranz-Yag{\"u}e, {Jos{\'e} Antonio} and Nolazco, {Jose Ignacio} and C{\'o}zar-Olmo, {Jose Manuel} and Joseph Bagley and Joseph Jelski and Joseph Norris and Joseph Testa and Joshua Meeks",

note = "Publisher Copyright: {\textcopyright} 2021 The Authors BJU International published by John Wiley & Sons Ltd on behalf of BJU International.",

year = "2021",

month = oct,

doi = "10.1111/bju.15483",

language = "English",

volume = "128",

pages = "440--450",

journal = "BJU international",

issn = "1464-4096",

number = "4",

}

TY - JOUR

T1 - The IDENTIFY study

T2 - the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer – a multicentre observational study

AU - IDENTIFY Study group

AU - Khadhouri, Sinan

AU - Gallagher, Kevin M.

AU - MacKenzie, Kenneth R.

AU - Shah, Taimur T.

AU - Gao, Chuanyu

AU - Moore, Sacha

AU - Zimmermann, Eleanor F.

AU - Edison, Eric

AU - Jefferies, Matthew

AU - Nambiar, Arjun

AU - Mannas, Miles P.

AU - Lee, Taeweon

AU - Marra, Giancarlo

AU - Lillaz, Beatrice

AU - Gómez Rivas, Juan

AU - Olivier, Jonathan

AU - Assmus, Mark A.

AU - Uçar, Taha

AU - Claps, Francesco

AU - Boltri, Matteo

AU - Burnhope, Tara

AU - Nkwam, Nkwam

AU - Tanasescu, George

AU - Boxall, Nicholas E.

AU - Downey, Alison P.

AU - Lal, Asim A.

AU - Antón-Juanilla, Marta

AU - Clarke, Holly

AU - Lau, David H.W.

AU - Gillams, Kathryn

AU - Crockett, Matthew

AU - Nielsen, Matthew

AU - Takwoingi, Yemisi

AU - Chuchu, Naomi

AU - O’Rourke, John

AU - MacLennan, Graeme

AU - McGrath, John S.

AU - Kasivisvanathan, Veeru

AU - Chaudry, Aasem

AU - Sharma, Abhishek

AU - Bennett, Adam

AU - Ahmad, Adnan

AU - Abroaf, Ahmed

AU - Suliman, Ahmed M.

AU - Lloyd, Aimee

AU - McKay, Alastair

AU - Wong, Albert

AU - Silva, Alberto

AU - Schneider, Alexandre

AU - MacKay, Alison

AU - Knight, Allen

AU - Grigorakis, Alkiviadis

AU - Bdesha, Amar

AU - Nagle, Amy

AU - Cebola, Ana

AU - Dhanasekaran, Ananda Kumar

AU - Kondža, Andraž

AU - Barcelos, André

AU - Galosi, Andrea B.

AU - Ebur, Andrea

AU - Minervini, Andrea

AU - Russell, Andrew

AU - Webb, Andrew

AU - García de Jalón, Ángel

AU - Desai, Ankit

AU - Czech, Anna K.

AU - Mainwaring, Anna

AU - Adimonye, Anthony

AU - Das, Arighno

AU - Figueiredo, Arnaldo

AU - Villers, Arnauld

AU - Leminski, Artur

AU - Chippagiri, Arvinda

AU - Yıldırım, Asıf

AU - Voulgaris, Athanasios M.

AU - Uzan, Audrey

AU - Oo, Aye Moh Moh

AU - Younis, Ayman

AU - Zelhof, Bachar

AU - Mukhtar, Bashir

AU - Ayres, Ben

AU - Challacombe, Ben

AU - Sherwood, Benedict

AU - Ristau, Benjamin

AU - Lai, Billy

AU - Nellensteijn, Brechtje

AU - Schreiter, Brielle

AU - Trombetta, Carlo

AU - Dowling, Catherine

AU - Hobbs, Catherine

AU - Benitez, Cayo Augusto Estigarribia

AU - Lebacle, Cédric

AU - Ho, Cherrie Wing Yin

AU - Ng, Chi Fai

AU - Mount, Chloe

AU - Lam, Chon Meng

AU - Blick, Chris

AU - Brown, Christian

AU - Gallegos, Christopher

AU - Higgs, Claire

AU - Browne, Clíodhna

AU - McCann, Conor

AU - Alonso, Cristina Plaza

AU - Beder, Daniel

AU - Cohen, Daniel

AU - Gordon, Daniel

AU - Wilby, Daniel

AU - Gordon, Danny

AU - Lau, David Hua Wu

AU - Hrouda, David

AU - Karsza, Dávid

AU - Mak, David

AU - Martin-Way, David

AU - Suthaharan, Denula

AU - Patel, Dhruv

AU - Carrion, Diego M.

AU - Nyanhongo, Donald

AU - Bass, Edward

AU - Mains, Edward

AU - Chau, Edwin

AU - Castillo, Elba Canelon

AU - Day, Elizabeth

AU - Desouky, Elsayed

AU - Gaines, Emily

AU - Papworth, Emma

AU - Yuruk, Emrah

AU - Kilic, Enes

AU - Dinneen, Eoin

AU - Palagonia, Erika

AU - Xylinas, Evanguelos

AU - Khawaja, Faizan

AU - Cimarra, Fernando

AU - Bardet, Florian

AU - Kum, Francesca

AU - Peters, Francesca

AU - Kovács, Gábor

AU - Tanasescu, Geroge

AU - Hellawell, Giles

AU - Tasso, Giovanni

AU - Lam, Gitte

AU - La Montagna, Giuseppe

AU - Pizzuto, Giuseppe

AU - Lenart, Gordan

AU - MacLennan, Graeme

AU - Özgür, Günal

AU - Bi, Hai

AU - Lyons, Hannah

AU - Warren, Hannah

AU - Ahmed, Hashim

AU - Simpson, Helen

AU - Burden, Helena

AU - Gresty, Helena

AU - Pita, Hernado Rios

AU - Clarke, Holly

AU - Serag, Hosam

AU - Kynaston, Howard

AU - Crawford-Smith, Hugh

AU - Mostafid, Hugh

AU - Otaola-Arca, Hugo

AU - Fen Koo, Hui

AU - Ibrahim, Ibrahim

AU - Ouzaid, Idir

AU - Puche-Sanz, Ignacio

AU - Tomašković, Igor

AU - Tinay, Ilker

AU - Sahibzada, Iqbal

AU - Thangasamy, Isaac

AU - Cadena, Iván Revelo

AU - Irani, Jacques

AU - Udzik, Jakub

AU - Brittain, James

AU - Catto, James

AU - Green, James

AU - Tweedle, James

AU - Hernando, Jamie Borrego

AU - Leask, Jamie

AU - Kalsi, Jas

AU - Frankel, Jason

AU - Toniolo, Jason

AU - Raman, Jay D.

AU - Courcier, Jean

AU - Kumaradeevan, Jeevan

AU - Clark, Jennifer

AU - Jones, Jennifer

AU - Teoh, Jeremy Yuen Chun

AU - Iacovou, John

AU - Kelly, John

AU - Selph, John P.

AU - Aning, Jonathan

AU - Deeks, Jon

AU - Olivier, Jonathan

AU - Maw, Jonny

AU - Herranz-Yagüe, José Antonio

AU - Nolazco, Jose Ignacio

AU - Cózar-Olmo, Jose Manuel

AU - Bagley, Joseph

AU - Jelski, Joseph

AU - Norris, Joseph

AU - Testa, Joseph

AU - Meeks, Joshua

PY - 2021/10

Y1 - 2021/10

N2 - Objective: 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. Patients and Methods: 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. Results: 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). Conclusions: 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.

AB - Objective: 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. Patients and Methods: 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. Results: 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). Conclusions: 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.

KW - bladder cancer

KW - cancer prevalence

KW - haematuria

KW - hematuria

KW - prostate cancer

KW - renal cancer

KW - upper tract urothelial cancer

KW - urinary tract cancer

UR - http://www.scopus.com/inward/record.url?scp=85115243675&partnerID=8YFLogxK

U2 - 10.1111/bju.15483

DO - 10.1111/bju.15483

M3 - Article

C2 - 33991045

AN - SCOPUS:85115243675

SN - 1464-4096

VL - 128

SP - 440

EP - 450

JO - BJU international

JF - BJU international

IS - 4

ER -

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer – a multicentre observational study

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