{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T18:09:06Z","timestamp":1788026946371,"version":"build-2784847793"},"reference-count":40,"publisher":"Royal College of General Practitioners","issue":"714","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To identify and compare published models that use clinical signs and symptoms to predict the risk of undiagnosed prevalent bladder or kidney cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>Systematic review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>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, data were extracted onto a standardised form. The risk models were classified using TRIPOD guidelines and evaluated using the PROBAST assessment tool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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. Several models (<jats:italic>n<\/jats:italic> = 13) with good discrimination (area under the receiver operating curve &gt;0.8) were identified; however, only eight had been externally validated. All of the studies had either high or unclear risk of bias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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 practice, external validations in appropriate populations are required.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgp.2021.0319","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T16:14:58Z","timestamp":1637252098000},"page":"e11-e18","source":"Crossref","is-referenced-by-count":13,"title":["Risk prediction models for symptomatic patients with bladder and kidney cancer: a systematic review"],"prefix":"10.3399","volume":"72","author":[{"given":"Hannah","family":"Harrison","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliet A","family":"Usher-Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lanxin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel E","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina H","family":"Rossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant D","family":"Stewart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona M","family":"Walter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Griffin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1987","published-online":{"date-parts":[[2021,9,24]]},"reference":[{"key":"2022011921351584000_72.714.e11.1","unstructured":"UK Cancer Research Bladder cancer statistics. https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/bladder-cancer (accessed 17 Nov 2021)."},{"key":"2022011921351584000_72.714.e11.2","unstructured":"UK Cancer Research Kidney cancer statistics. https:\/\/www.cancerresearchuk.org\/health-professional\/cancer-statistics\/statistics-by-cancer-type\/kidney-cancer (accessed 17 Nov 2021)."},{"key":"2022011921351584000_72.714.e11.3","unstructured":"National Cancer Intelligence Network (2017) Routes to diagnosis 2006\u20132015 workbook, http:\/\/www.ncin.org.uk\/publications\/routes_to_diagnosis (accessed 17 Nov 2021)."},{"key":"2022011921351584000_72.714.e11.4","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2015.48"},{"key":"2022011921351584000_72.714.e11.5","doi-asserted-by":"crossref","unstructured":"Arhi CS Burns EM Bottle A (2020) Delays in referral from primary care worsen survival for patients with colorectal cancer: a retrospective cohort study. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/bjgp20X710441.","DOI":"10.3399\/bjgp20X710441"},{"issue":"1","key":"2022011921351584000_72.714.e11.6","doi-asserted-by":"crossref","first-page":"156","DOI":"10.3390\/cancers13010156","article-title":"Prolonged diagnostic intervals as marker of missed diagnostic opportunities in bladder and kidney cancer patients with alarm features: a longitudinal linked data study","volume":"13","author":"Zhou","year":"2021","journal-title":"Cancers (Basel)"},{"issue":"7","key":"2022011921351584000_72.714.e11.7","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1007\/s12325-019-00966-x","article-title":"Improving the timely detection of bladder and kidney cancer in primary care","volume":"36","author":"Zhou","year":"2019","journal-title":"Adv Ther"},{"key":"2022011921351584000_72.714.e11.8","unstructured":"National Institute for Health and Care Excellence (2021) Suspected cancer: recognition and referral NG12, http:\/\/www.nice.org.uk\/guidance\/NG12 (accessed 17 Nov 2021)."},{"issue":"1","key":"2022011921351584000_72.714.e11.9","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1038\/bjc.2017.381","article-title":"Variation in \u2018fast-track\u2019 referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670 000 patients with cancers of 35 different sites","volume":"118","author":"Zhou","year":"2018","journal-title":"Br J Cancer"},{"issue":"10","key":"2022011921351584000_72.714.e11.10","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1001\/jamainternmed.2019.2280","article-title":"Comparison of the harms, advantages, and costs associated with alternative guidelines for the evaluation of hematuria","volume":"179","author":"Georgieva","year":"2019","journal-title":"JAMA Intern Med"},{"key":"2022011921351584000_72.714.e11.11","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp13X660751"},{"issue":"1","key":"2022011921351584000_72.714.e11.12","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1186\/s12885-020-07572-z","article-title":"Development, validation and effectiveness of diagnostic prediction tools for colorectal cancer in primary care: a systematic review","volume":"20","author":"Grigore","year":"2020","journal-title":"BMC Cancer"},{"key":"2022011921351584000_72.714.e11.13","doi-asserted-by":"crossref","unstructured":"Hamilton W Green T Martins T (2013) Evaluation of risk assessment tools for suspected cancer in general practice: a cohort study. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/bjgp13X660751.","DOI":"10.3399\/bjgp13X660751"},{"key":"2022011921351584000_72.714.e11.14","doi-asserted-by":"publisher","DOI":"10.7326\/M14-0698"},{"key":"2022011921351584000_72.714.e11.15","doi-asserted-by":"publisher","DOI":"10.7326\/M18-1377"},{"key":"2022011921351584000_72.714.e11.16","doi-asserted-by":"publisher","DOI":"10.7326\/M18-1376"},{"issue":"5","key":"2022011921351584000_72.714.e11.17","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1111\/j.1464-410X.2011.010419.x","article-title":"Decision curve analysis assessing the clinical benefit of NMP22 in the detection of bladder cancer: secondary analysis of a prospective trial","volume":"109","author":"Barbieri","year":"2012","journal-title":"BJU Int"},{"issue":"10","key":"2022011921351584000_72.714.e11.18","doi-asserted-by":"crossref","first-page":"e77657","DOI":"10.1371\/journal.pone.0077657","article-title":"The use of molecular analyses in voided urine for the assessment of patients with hematuria","volume":"8","author":"Beukers","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"2022011921351584000_72.714.e11.19","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.eururo.2011.08.073","article-title":"Immunocytology is a strong predictor of bladder cancer presence in patients with painless hematuria: a multicentre study","volume":"61","author":"Cha","year":"2012","journal-title":"Eur Urol"},{"issue":"6","key":"2022011921351584000_72.714.e11.20","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00345-012-0979-x","article-title":"Accurate risk assessment of patients with asymptomatic hematuria for the presence of bladder cancer","volume":"30","author":"Cha","year":"2012","journal-title":"World J Urol"},{"issue":"11","key":"2022011921351584000_72.714.e11.21","doi-asserted-by":"crossref","first-page":"6327","DOI":"10.7314\/APJCP.2013.14.11.6327","article-title":"Stratifying patients with haematuria into high or low risk groups for bladder cancer: a novel clinical scoring system","volume":"14","author":"Hee","year":"2013","journal-title":"Asian Pac J Cancer Prev"},{"key":"2022011921351584000_72.714.e11.22","doi-asserted-by":"crossref","unstructured":"Hippisley-Cox J Coupland C (2012) Identifying patients with suspected renal tract cancer in primary care: derivation and validation of an algorithm. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/bjgp12X636074.","DOI":"10.3399\/bjgp12X636074"},{"key":"2022011921351584000_72.714.e11.23","doi-asserted-by":"crossref","unstructured":"Hippisley-Cox J Coupland C (2013) Symptoms and risk factors to identify men with suspected cancer in primary care: derivation and validation of an algorithm. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/bjgp13X660724.","DOI":"10.3399\/bjgp13X660724"},{"key":"2022011921351584000_72.714.e11.24","doi-asserted-by":"crossref","unstructured":"Hippisley-Cox J Coupland C (2013) Symptoms and risk factors to identify women with suspected cancer in primary care: derivation and validation of an algorithm. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/bjgp13X660733.","DOI":"10.3399\/bjgp13X660733"},{"key":"2022011921351584000_72.714.e11.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2010.02.414."},{"issue":"16","key":"2022011921351584000_72.714.e11.26","doi-asserted-by":"crossref","first-page":"6819","DOI":"10.7314\/APJCP.2014.15.16.6819","article-title":"External validation of a clinical scoring system for hematuria","volume":"15","author":"Lee","year":"2014","journal-title":"Asian Pac J Cancer Prev"},{"issue":"2","key":"2022011921351584000_72.714.e11.27","doi-asserted-by":"crossref","first-page":"146.e1","DOI":"10.1016\/j.ajog.2016.10.008","article-title":"Evaluation of microscopic hematuria and risk of urologic cancer in female patients","volume":"216","author":"Lippmann","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"2022011921351584000_72.714.e11.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2012.10.004"},{"issue":"10","key":"2022011921351584000_72.714.e11.29","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1111\/j.1464-410X.2009.08360.x","article-title":"Impact of clinical factors, including a point-of-care nuclear matrix protein-22 assay and cytology, on bladder cancer detection","volume":"103","author":"Lotan","year":"2009","journal-title":"BJU Int"},{"issue":"5","key":"2022011921351584000_72.714.e11.30","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1016\/j.juro.2014.05.087","article-title":"Prospective external validation of a bladder cancer detection model","volume":"192","author":"Lotan","year":"2014","journal-title":"J Urol"},{"key":"2022011921351584000_72.714.e11.31","doi-asserted-by":"crossref","unstructured":"Shephard E Neal R Rose P (2013) Clinical features of kidney cancer in primary care: a case-control study using primary care records. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/bjgp13X665215.","DOI":"10.3399\/bjgp13X665215"},{"key":"2022011921351584000_72.714.e11.32","doi-asserted-by":"crossref","unstructured":"Shephard EA Stapley S Neal RD (2012) Clinical features of bladder cancer in primary care. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/bjgp12X654560.","DOI":"10.3399\/bjgp12X654560"},{"issue":"4","key":"2022011921351584000_72.714.e11.33","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/joim.12868","article-title":"Development and validation of a haematuria cancer risk score to identify patients at risk of harbouring cancer","volume":"285","author":"Tan","year":"2019","journal-title":"J Intern Med"},{"issue":"4","key":"2022011921351584000_72.714.e11.34","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.urolonc.2019.12.010","article-title":"A simplified nomogram to assess risk of bladder cancer in patients with a new diagnosis of microscopic hematuria","volume":"38","author":"Matulewicz","year":"2020","journal-title":"Urol Oncol"},{"key":"2022011921351584000_72.714.e11.35","doi-asserted-by":"crossref","unstructured":"Price SJ Shephard EA Stapley SA (2014) Non-visible versus visible haematuria and bladder cancer risk: a study of electronic records in primary care. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/bjgp14X681409.","DOI":"10.3399\/bjgp14X681409"},{"issue":"4","key":"2022011921351584000_72.714.e11.36","first-page":"190","article-title":"Diagnostic utility of the immunoCyt\/uCyt+ test in bladder cancer","volume":"8","author":"Greene","year":"2006","journal-title":"Rev Urol"},{"issue":"1","key":"2022011921351584000_72.714.e11.37","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s12876-016-0475-7","article-title":"Risk prediction models for colorectal cancer in people with symptoms: a systematic review","volume":"16","author":"Williams","year":"2016","journal-title":"BMC Gastroenterol"},{"issue":"12","key":"2022011921351584000_72.714.e11.38","doi-asserted-by":"crossref","first-page":"3686","DOI":"10.3390\/cancers12123686","article-title":"Identifying ovarian cancer in symptomatic women: a systematic review of clinical tools","volume":"12","author":"Funston","year":"2020","journal-title":"Cancers (Basel)"},{"key":"2022011921351584000_72.714.e11.39","doi-asserted-by":"crossref","unstructured":"Schmidt-Hansen M Berendse S Hamilton W (2015) The association between symptoms and bladder or renal tract cancer in primary care: a systematic review. Br J Gen Pract, DOI: https:\/\/doi.org\/10.3399\/bjgp15X687421.","DOI":"10.3399\/bjgp15X687421"},{"key":"2022011921351584000_72.714.e11.40","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a3021"}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/BJGP.2021.0319","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T19:20:30Z","timestamp":1645816830000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjgp.org\/lookup\/doi\/10.3399\/BJGP.2021.0319"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,24]]},"references-count":40,"journal-issue":{"issue":"714","published-online":{"date-parts":[[2021,12,31]]},"published-print":{"date-parts":[[2022,1]]}},"alternative-id":["10.3399\/BJGP.2021.0319"],"URL":"https:\/\/doi.org\/10.3399\/bjgp.2021.0319","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,24]]}}}