Haematuria cancer risk score as a predictor of muscle-invasive bladder cancer.

OBJECTIVE

To evaluate the prognostic performance of the Haematuria Cancer Risk Score (HCRS) for predicting muscle-invasive bladder cancer (MIBC) in patients presenting with haematuria.

METHODS

This retrospective study analysed newly diagnosed urothelial carcinoma cases identified during haematuria evaluations between 2018 and 2023. Pathological staging was based on the highest grade or stage from TUR or re-TUR specimens. HCRS was calculated using age, sex, haematuria type, and smoking status. The primary outcome was muscle-invasive disease (≥T2). Associations were examined using univariate logistic regression, and discriminatory performance was evaluated with ROC analysis and bootstrap-derived 95% confidence intervals.

RESULTS

Among 162 patients, 45 (27.8%) had MIBC. The median HCRS was higher in patients with MIBC than in those with non-muscle-invasive disease (6.49 [6.08-6.96] vs. 6.16 [5.44-6.94]; p = 0.04). Univariate analysis showed a significant association between HCRS and MIBC (odds ratio = 1.78; 95% CI 1.03-3.06; p = 0.039). ROC analysis demonstrated limited discriminative performance (AUC = 0.60; 95% CI 0.53-0.67). At the Youden cut-off of 6.04, sensitivity was 77.8% and specificity 48.3%. An integer threshold of HCRS ≥6 yielded comparable performance, supporting clinical applicability.

CONCLUSIONS

Higher HCRS values were modestly associated with muscle invasion, although predictive performance was limited. The HCRS may support risk stratification in haematuria pathways by flagging patients at higher risk of muscle invasion-particularly when interpreted together with cystoscopy and imaging findings.