Impact of antiplatlet or anticoagulation therapy in patients newly diagnosed bladder cancer: Preliminary results of a independent analysis of the Identify Study Italian cohort

Aim of the study: The most common symptom of bladder cancer (BCa) is haematuria. Although macroscopic haematuria has long been assumed to be the earliest and most frequent symptom of BCa, its effect on current urologic practice deserves better investigation because of some novel epidemiologic and clinical findings. Antiplatelet and anticoagulant therapy (AAT) represents one of the most widely used treatments in medical practice. The aim of this study is to evaluate whether patients taking AAT might experience haematuria at an earlier stage or grade of BCa in the setting of IDENTIFY study: the largest ever prospective, international, multicentre study of patients referred to secondary care, with or without haematuria, for the investigation of suspected urinary tract cancer. Materials and methods: Data were collected prospectively from five Italian tertiary referral centers including 618 consecutive patients undergoing cystoscopy because of urothelial cancer suspicion and with no history of previous urological tumours, from December 2017 to May 2018. For the purpose of this sub-analysis patients with subsequent diagnosis of BCa were divided into two groups: patients receiving antiplatelet or anticoagulant therapy (AAT) and patients who are not receiving it at the moment of enrollment. Results: We included 109 patients with complete follow up and histopathology. 34 (31,2%) of patients took AAT at the time of enrollment. The mean age of the population was 72.3 years (\ub111.4, SD) and the majority of patients were males (88.9%). Distribution of data in BMI, smoke habits, family history of urological cancer, tumour focality, tumor size, tumour location, final pT stage, grading according to WHO and histologic variants of BCa was homogenous (all p > 0.05). Data regarding mean age at recruitment (p < 0.0001), gender (p = 0.02), type of haematuria (visible or not, p < 0.0001) were statistically significantly different between the two populations. A multivariable binomial logistic regression analysis adjusted for age, sex, tumour size, tumour focality, active smoke habit and AAT confirmed the absence of statistically significant differences in predict high grade or stage BCa at final pathology report (p = 0.43). Discussion: In this preliminary independent analysis of the Italian cohort of the IDENTIFY study, patients without history of urological malignacies undergoing cystoscopy because of suspicious urothelial cancer do not seem to experience haematuria significantly earlier (regarding pT stage and or grading) if using AAT. Whilst IDENTIFY definitive results are awaited to confirm our findings, investigation for suspect urothelial cancers should not differ from the standard in these patients

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