Aim of the study: Bladder cancer (BC) is the eleventh most commonly
diagnosed cancer worldwide. The aim of this work was to evaluate the
most significant predictive factors for the likelihood of bladder cancer
based on the related risk factors in a contemporary Italian cohort.
Materials and methods: Demographic and clinical data were obtained
from five Italian centers participating to the IDENTIFY study from
December 2017 to May 2018, a large prospective, international,
multicentric study of patients undergoing cystoscopy, with or
without hematuria, for the investigation of suspected urinary tract
cancer. Patients with previous urological cancer were excluded. Age,
sex, Body Max Index (BMI), Smoke habit, family history of urological
malignancies, professional exposure and hematuria (macroscopic or
microscopic) data were collected. All cystoscopic urothelial cancer
diagnosis were confirmed by subsequent pathological examination.
The predictive value of each variable was measured using univariate
analysis and multinomial logistic regression to develop the multivariate analysis.
Results: We recorded data of 618 patients from five Italian academic
centers, 437 patients presented complete data and follow up and were
included in the final analysis. 351 (80.3%) of the patients were male.
Patients older than 60 years were the majority (80.1%). The smoke
habit was present in 252 subjects (65.8%). Familiar history of urological
malignancies was positive in 115 patients (26.3%). Patients presenting
macroscopic hematuria were 320 (73.2%) while microscopic hematuria was demonstrated in 27 (6.2%) subjects. Professional exposure to related risk factors was present in 41 patients. Results of the univariate
analysis in the prediction of BC are shown in the tables below. Male
status (p < 0.001), age older than 60 years old (p = 0.02), smoke habit
(p < 0.001), family history (p < 0.001) and multiple hematuria episodes (p < 0.001) were significantly associated with the risk of having
diagnostic cystoscopy positive for urothelial cancer whilst BMI and
professional exposure were not (p > 0.05). On the multivariate analysis
current or previous smoking status (p = 0.007) and hematuria (macro
or micro) (p = 0.023) were predictors of a diagnosis of urothelial cancer
at cystoscopy.
Discussion: In this independent analysis of the Italian cohort of the
IDENTIFY study, macro-hematuria and smoke habit better predicted
the likelihood of bladder cancer in patients undergoing cystoscopy for
urothelial cancer suspicion. Final results of the IDENTIFY study are
awaited to confirm our findings.
