Risk factors of bladder cancer in patients undergoing transurethral cystoscopy: A multicentric italian experience from the IDENTIFY study cohort

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.