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Risk prediction models for symptomatic patients with bladder and kidney cancer: a systematic review

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Usher-Smith, Juliet  ORCID logo
Li, Lanxin 
Roberts, Lydia 
Lin, Zhiyuan 


Background Timely diagnosis of bladder and kidney cancer is key to improving clinical outcomes. Given the challenges of early diagnosis, models incorporating clinical symptoms and signs may be helpful to primary care clinicians when triaging at risk patients. Aim This review identifies and compares published models that use clinical signs and symptoms to predict the risk of undiagnosed prevalent kidney or bladder cancer. Method A search identified primary research reporting or validating models predicting the risk of bladder or kidney cancer in Medline and EMBASE. After screening identified studies for inclusion, we extracted data onto a standardised form. The risk models were classified using TRIPOD guidelines and evaluated using the PROBAST assessment tool.


The search identified 20,661 articles. Twenty studies (29 models) were identified through screening. All the models included haematuria (visible, non-visible or unspecified), and seven included additional signs and symptoms (such as abdominal pain). The models combined clinical features with other factors (including demographic factors and urinary biomarkers) to predict the risk of undiagnosed prevalent cancer. Most models (n=24) had acceptable-to-good discrimination (AUROC>0.7), however, only six have been externally validated. All of the studies had either high or unclear risk of bias (RoB). Conclusion

Models were identified that could be used in primary care to guide referrals, with potential to identify lower risk patients with visible haematuria and to stratify individuals who present with non-visible haematuria. However, before application in general practise external validations in appropriate populations are required.



bladder cancer, early diagnosis, kidney cancer, risk prediction, systematic review, Bias, Biomarkers, Hematuria, Humans, Kidney Neoplasms, Urinary Bladder

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British Journal of General Practice

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Royal College of General Practitioners
Department of Health (via National Institute for Health Research (NIHR)) (21823/NIHR301182)
MRC (MC_UU_00006/6)
Cancer Research UK (C96/A25177)
Cancer Research UK (21464)
HH was supported by a National Institute of Health Research Methods Fellowship (RM-SR-2017-09-009) and is now supported by a National Institute of Health Research Development and Skills Enhancement Award (NIHR301182). JUS was funded by a Cancer Research UK Prevention Fellowship (C55650/A21464). The University of Cambridge has received salary support in respect of SJG from the NHS in the East of England through the Clinical Academic Reserve. SHR is funded by a Cancer Research UK Clinical PhD Fellowship. GDS is funded by the Renal Cancer Research Fund, Kidney Cancer UK, Mark Foundation for Cancer Research, Cancer Research UK Cambridge Centre [C9685/A25177] and NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). FMW is co-director of the CanTest Collaborative, which is funded by Cancer Research UK (CC8640/A23385). YZ is funded by a Wellcome Trust Primary Care Clinician PhD Fellowship (20391/Z/16/Z). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.