Prospective external validation of a bladder cancer detection model

Yair Lotan, Robert S. Svatek, Laura Maria Krabbe, Evanguelos Xylinas, Tobias Klatte, Shahrokh F. Shariat

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Purpose: Few studies have combined clinical prognostic factors with urinary biomarkers into risk profiles that can be used to predict the likelihood of bladder cancer. We previously developed and internally validated a bladder cancer detection nomogram that combines clinical features with the NMP22®BladderChek®test. To consider extensive use of the model the nomogram was tested in a prospective cohort of patients who presented with hematuria.

Materials and Methods: Patients referred for hematuria evaluation were prospectively enrolled at 3 centers. Each patient underwent complete urological evaluation, including history, examination, cystoscopy, cytology and NMP22. A logistic regression model to predict urothelial bladder carcinoma was also developed to compare the performance of clinical data with and without adding NMP22 and urinary cytology.

Results: The study included 381 patients (50.7% women) with a median age of 58 years. Urothelial bladder carcinoma was detected in 23 patients (6%). It was associated with age greater than 65 (11.1% vs 4% of patients, p =0.012), male gender (10.1% vs 2%, p =0.003), white ethnicity (9.2% vs 3.1%, p =0.016), gross hematuria (9.9% vs 2.5%, p =0.005), positive NMP22 (37% vs 3.7%, p <0.001) and positive cytology (83.3% vs 3.9%, p <0.001). Predictive accuracy of the bladder cancer detection nomogram was 80.2%. The calibration plot indicated that the previously published nomogram was well calibrated in patients with a less than 15% predicted probability of urothelial bladder carcinoma.

Conclusions: We prospectively validated a highly accurate tool that combines clinical factors and a urinary biomarker to detect bladder cancer. This tool can help prioritize urological referrals for patients with hematuria.

Original languageEnglish (US)
Pages (from-to)1343-1348
Number of pages6
JournalJournal of Urology
Volume192
Issue number5
DOIs
StatePublished - Nov 1 2014

Fingerprint

Urinary Bladder Neoplasms
Nomograms
Hematuria
Cell Biology
Urinary Bladder
Carcinoma
Biomarkers
Logistic Models
Cystoscopy
Calibration
Referral and Consultation
History
nuclear matrix protein 22

Keywords

  • hematuria
  • nuclear matrix protein 22
  • prognosis
  • urinary bladder
  • urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Lotan, Y., Svatek, R. S., Krabbe, L. M., Xylinas, E., Klatte, T., & Shariat, S. F. (2014). Prospective external validation of a bladder cancer detection model. Journal of Urology, 192(5), 1343-1348. https://doi.org/10.1016/j.juro.2014.05.087

Prospective external validation of a bladder cancer detection model. / Lotan, Yair; Svatek, Robert S.; Krabbe, Laura Maria; Xylinas, Evanguelos; Klatte, Tobias; Shariat, Shahrokh F.

In: Journal of Urology, Vol. 192, No. 5, 01.11.2014, p. 1343-1348.

Research output: Contribution to journalArticle

Lotan, Y, Svatek, RS, Krabbe, LM, Xylinas, E, Klatte, T & Shariat, SF 2014, 'Prospective external validation of a bladder cancer detection model', Journal of Urology, vol. 192, no. 5, pp. 1343-1348. https://doi.org/10.1016/j.juro.2014.05.087
Lotan Y, Svatek RS, Krabbe LM, Xylinas E, Klatte T, Shariat SF. Prospective external validation of a bladder cancer detection model. Journal of Urology. 2014 Nov 1;192(5):1343-1348. https://doi.org/10.1016/j.juro.2014.05.087
Lotan, Yair ; Svatek, Robert S. ; Krabbe, Laura Maria ; Xylinas, Evanguelos ; Klatte, Tobias ; Shariat, Shahrokh F. / Prospective external validation of a bladder cancer detection model. In: Journal of Urology. 2014 ; Vol. 192, No. 5. pp. 1343-1348.
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abstract = "Purpose: Few studies have combined clinical prognostic factors with urinary biomarkers into risk profiles that can be used to predict the likelihood of bladder cancer. We previously developed and internally validated a bladder cancer detection nomogram that combines clinical features with the NMP22{\circledR}BladderChek{\circledR}test. To consider extensive use of the model the nomogram was tested in a prospective cohort of patients who presented with hematuria.Materials and Methods: Patients referred for hematuria evaluation were prospectively enrolled at 3 centers. Each patient underwent complete urological evaluation, including history, examination, cystoscopy, cytology and NMP22. A logistic regression model to predict urothelial bladder carcinoma was also developed to compare the performance of clinical data with and without adding NMP22 and urinary cytology.Results: The study included 381 patients (50.7{\%} women) with a median age of 58 years. Urothelial bladder carcinoma was detected in 23 patients (6{\%}). It was associated with age greater than 65 (11.1{\%} vs 4{\%} of patients, p =0.012), male gender (10.1{\%} vs 2{\%}, p =0.003), white ethnicity (9.2{\%} vs 3.1{\%}, p =0.016), gross hematuria (9.9{\%} vs 2.5{\%}, p =0.005), positive NMP22 (37{\%} vs 3.7{\%}, p <0.001) and positive cytology (83.3{\%} vs 3.9{\%}, p <0.001). Predictive accuracy of the bladder cancer detection nomogram was 80.2{\%}. The calibration plot indicated that the previously published nomogram was well calibrated in patients with a less than 15{\%} predicted probability of urothelial bladder carcinoma.Conclusions: We prospectively validated a highly accurate tool that combines clinical factors and a urinary biomarker to detect bladder cancer. This tool can help prioritize urological referrals for patients with hematuria.",
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