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Maas M, Chen A, Asanad K, Nabhani J. Evaluation of Recurrent Gross Hematuria in a Patient With Metastatic Prostate and Concomitant Metastatic Kidney Cancer. Urology 2023; 177:e1-e2. [PMID: 37030581 DOI: 10.1016/j.urology.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/10/2023]
Affiliation(s)
- Marissa Maas
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Andrew Chen
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kian Asanad
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jamal Nabhani
- Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Okholm SH, Nagy D, Körmendiné Farkas D, Fuglsang CH, Troelsen FS, Henderson VW, Sørensen HT. Non-Traumatic Subdural Hematoma and Cancer: A Cohort Study. Clin Epidemiol 2023; 15:629-633. [PMID: 37187767 PMCID: PMC10178369 DOI: 10.2147/clep.s408667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Cancer may increase the risk of bleeding. However, whether subdural hematoma is a marker of occult cancer remains unknown. We examined the association between non-traumatic subdural hematoma and cancer risk in a cohort study. Materials and Methods Using Danish nationwide health registries, we identified 2713 patients with non-traumatic subdural hematoma and no previous cancer diagnosis, who were hospitalized between April 1, 1996 and December 31, 2019. We computed age-, sex-, and calendar year-standardized incidence ratios (SIRs) as the ratio of the observed to expected number of patients with cancer by using national incidence rates as reference as a measure of relative risk. Results We identified 77 cancer cases within the first year of follow-up and 272 cancer cases thereafter. The one-year risk of cancer was 2.8% (95% confidence interval: 2.2-3.5), and the one-year SIR was 1.7 (95% confidence interval: 1.3-2.1). During the subsequent years, the SIR was 1.0 (95% confidence interval: 0.9-1.1). The relative risk was elevated for some hematological and liver cancers. Conclusion The risk of a new cancer diagnosis was clearly increased in patients with non-traumatic subdural hematoma compared with the general population during the first year of follow-up. However, the absolute risk was low, thus limiting the clinical relevance of pursuing early cancer detection in these patients.
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Affiliation(s)
- Søren Hauge Okholm
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dávid Nagy
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dóra Körmendiné Farkas
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Cecilia Hvitfeldt Fuglsang
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Victor W Henderson
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Departments of Epidemiology & Population Health and of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Correspondence: Henrik Toft Sørensen, Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43-45, Aarhus N, 8200, Denmark, Tel +45 87 16 82 15, Email
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Hansen RS, Biørn SH, Birk-Korch JB, Sheikh SP, Poulsen MH, Vinholt PJ. Prevalence of prostate cancer in men with haematuria: a systematic review and meta-analysis. BJU Int 2022; 131:530-539. [PMID: 36522728 DOI: 10.1111/bju.15950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate the prevalence of prostate cancer in men attending evaluation for haematuria, as this could help healthcare providers to determine whether men with haematuria should have prostate examinations performed. METHODS The study was performed according to a pre-specified protocol uploaded to the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022299383). A systematic search of MEDLINE, Ovid and Google Scholar was performed in December 2021. Two independent researchers evaluated all titles, available abstracts, and full texts. We included studies on adult men (aged ≥18 years) describing haematuria and prostate cancer. RESULTS We screened 4252 titles and abstracts when available and assessed 350 studies in full text. In total, 65 studies were included and 42 was summarised in a meta-analysis. In total, 18 752 men with haematuria were included, and the pooled prevalence (95% confidence interval [CI]) of prostate cancer was 3.0% (2.0-4.1%). In men with macroscopic haematuria, the pooled prevalence (95% CI) of prostate cancer was 5.9% (2.9-9.9%; n = 265/5373). In men with microscopic haematuria, the pooled prevalence (95% CI) of prostate cancer was 1.4% (0.8-2.2%; n = 71/6642). CONCLUSION Our findings indicate that the prevalence of prostate cancer is considerable in men attending evaluation for haematuria. Therefore, digital rectal examination and prostate-specific antigen measurement should become a standard procedure for all men with haematuria, especially for men with macroscopic haematuria.
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Affiliation(s)
- Rasmus Søgaard Hansen
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | - Signe Hedengran Biørn
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | | | - Søren Paludan Sheikh
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | - Mads Hvid Poulsen
- Department of Urology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | - Pernille Just Vinholt
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
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Ahn Y, Lee D, Choo EH, Choi IJ, Lim S, Lee KY, Hwang B, Park M, Lee J, Park CS, Kim H, Yoo K, Jeon DS, Chung WS, Kim MC, Jeong MH, Ahn Y, Chang K. Association Between Bleeding and New Cancer Detection and the Prognosis in Patients With Myocardial Infarction. J Am Heart Assoc 2022; 11:e026588. [DOI: 10.1161/jaha.122.026588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background
Antithrombotic agents to treat patients with acute myocardial infarction can cause bleeding, which may reveal undiagnosed cancer. However, the relationship between bleeding and new cancer diagnosis and the prognostic impact is still unclear.
Methods and Results
We analyzed the new cancer diagnosis, Bleeding Academic Research Consortium 2, 3, or 5 bleeding, and all‐cause death of 10 364 patients with acute myocardial infarction without a history of previous cancer in a multicenter acute myocardial infarction registry. During a median of 4.9 years, 1109 patients (10.7%) experienced Bleeding Academic Research Consortium 2, 3, or 5 bleeding, and 338 patients (3.3%) were newly diagnosed with cancer. Bleeding Academic Research Consortium 2, 3, or 5 bleeding was associated with an increased risk of new cancer diagnosis (subdistribution hazard ratio [sHR] 3.29 [95% CI, 2.50–4.32]). In particular, there were robust associations between gastrointestinal bleeding and new gastrointestinal cancer diagnosis (sHR, 19.96 [95% CI, 11.30–29.94]) and between genitourinary bleeding and new genitourinary cancer diagnosis (sHR, 28.95 [95% CI, 14.69–57.07]). The risk of all‐cause death was not lower in patients diagnosed with new gastrointestinal cancer after gastrointestinal bleeding (hazard ratio [HR], 4.05 [95% CI, 2.04–8.02]) and diagnosed with new genitourinary cancer after genitourinary bleeding (HR, 2.79 [95% CI, 0.81–9.56]) than in patients newly diagnosed with cancer without previous bleeding.
Conclusions
Clinically significant bleeding, especially gastrointestinal and genitourinary bleeding, in patients with AMI was associated with an increased risk of new cancer diagnoses. However, the bleeding preceding new cancer detection was not associated with better survival.
Registration
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02385682 and NCT02806102.
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Affiliation(s)
- Youngcheol Ahn
- Division of Cardiology, Department of Internal Medicine Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Dongjae Lee
- Division of Cardiology, Department of Internal Medicine Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Eun Ho Choo
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Ik Jun Choi
- Division of Cardiology, Department of Internal Medicine Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Sungmin Lim
- Division of Cardiology, Department of Internal Medicine Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Byung‐Hee Hwang
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Mahn‐Won Park
- Division of Cardiology, Department of Internal Medicine Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Daejeon Republic of Korea
| | - Jong‐Min Lee
- Division of Cardiology, Department of Internal Medicine Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Chul Soo Park
- Division of Cardiology, Department of Internal Medicine Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Hee‐Yeol Kim
- Division of Cardiology, Department of Internal Medicine Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Ki‐Dong Yoo
- Division of Cardiology, Department of Internal Medicine St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea Suwon Republic of Korea
| | - Doo Soo Jeon
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Wook Sung Chung
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Min Chul Kim
- Division of Cardiology, Department of Internal Medicine Chonnam National University Gwangju Republic of Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine Chonnam National University Gwangju Republic of Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine Chonnam National University Gwangju Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
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Fogh K, Vestergaard SV, Christiansen CF, Pedersen L, Nitsch D, Nørgaard M. Hematuria and subsequent long-term risk of end-stage kidney disease: A Danish population-based cohort study. Eur J Intern Med 2022; 96:90-96. [PMID: 34776328 DOI: 10.1016/j.ejim.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hematuria is a frequent incidental clinical finding and may be a symptom of pre-existing underlying benign or malignant urinary tract or kidney disease. However, in patients with no apparent underlying cause of hematuria, long-term prognosis of hematuria remains unknown. OBJECTIVES To assess the long-term risk of end-stage-kidney disease (ESKD) in patients with a hospital-based hematuria diagnosis and no apparent underlying cause. METHODS Patients with a hospital diagnosis of hematuria were included and matched in a 1:5 ratio with comparison persons from the background population by age, sex and residency. We calculated the cumulative risk of ESKD considering death as a competing risk. Furthermore, we computed unadjusted and adjusted hazard ratios with 95% confidence intervals using Cox hazard regression with adjustment for age, sex, and comorbidities. RESULTS We included 170,189 hematuria-diagnosed patients. The absolute 10-year risk of ESKD was 0.7% (95%CI: 0.7-0.8) in patients with hematuria and 0.4% (95%CI: 0.3-0.4) in comparison persons, hence yielding an overall adjusted hazard ratio of 1.6 (95%CI: 1.4-1.7). Hematuria also increased the risk of EKSD in patients with pre-existing comorbidities like diabetes (adjusted HR: 1.3 [95%CI: 1.1-1.5]) and urogenital cancer (adjusted HR: 1.4 ([95%CI: 1.1-1.9]), whereas no association was observed in patients with previous kidney disease (adjusted HR: 0.9 (95%CI: 0.8-1.0). CONCLUSION A hospital-based hematuria diagnosis in patients with no apparent underlying cause of hematuria is a marker of an increased risk of future ESKD.
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Affiliation(s)
- Kristine Fogh
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Søren Viborg Vestergaard
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
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Carabineanu A, Zaharia C, Blidisel A, Ilina R, Miclaus C, Ardelean O, Preda M, Mazilu O. Risk of More Advanced Lesions at Hysterectomy after Initial Diagnosis of Non-Atypical Endometrial Hyperplasia in Patients with Postmenopausal Bleeding and Oral Anticoagulant Treatment. ACTA ACUST UNITED AC 2021; 57:medicina57101003. [PMID: 34684040 PMCID: PMC8539967 DOI: 10.3390/medicina57101003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
Background and Objectives: Endometrial hyperplasia (EH) is a precursor lesion to endometrial cancer (EC), and when cellular atypia is present, in 40% of cases, they are diagnosed with EC on hysterectomy. Usually, EH is clinically manifested by uterine bleeding. In patients with oral anticoagulant therapy (OAT), the uterus is the second most common source of bleeding. The aim of the study was to show that uterine bleeding in postmenopausal patients undergoing OAT may reveal precancerous endometrial lesions with atypia, or neoplastic lesions in patients with an initial diagnosis of endometrial hyperplasia without atypia (non-atypical endometrial hyperplasia, NAEH) on dilation and curettage (D&C). We will be able to estimate the risk of a postmenopausal female patient with uterine bleeding during an OAT to have a precancerous endometrial lesion. Materials and Methods: The subjects of the study were 173 female patients with uterine bleeding, who have had total hysterectomy with bilateral salpingoovarectomy, of whom 99 underwent an OAT. There were 101 female patients initially diagnosed with NAEH, of which 60 did not have anticoagulant treatment (mean age 57.36 ± 6.51) and 41 had anticoagulant treatment (mean age 60.39 ± 7.35) (p = 0.006). From the pathology diagnosis moment, the surgery was performed at 42.09 ± 14.54 days in patients without OAT and after 35.39 ± 11.29 days in those who received such treatment (p = 0.724). Results: Initial diagnosis of NAEH established at D&C was changed at the final diagnosis after hysterectomy in EH with cellular atypia (atypical endometrial hyperplasia AEH) or EC in 18.18% of patients without OAT, and in 40.54% of patients who received this treatment. Conclusions: Based on a logistic regression model, it is estimated that female patients with an initial histopathological diagnosis of NAEH and who underwent OAT have, on average, 4.85 times greater odds (OR = 4.85, 95% CI 1.79–14.06) than the others of being identified postoperatively with more advanced lesions.
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Affiliation(s)
- Adrian Carabineanu
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Claudia Zaharia
- Department of Mathematics, Faculty of Mathematics and Computer Science, West University of Timisoara, 300223 Timisoara, Romania;
| | - Alexandru Blidisel
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
- Correspondence:
| | - Razvan Ilina
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Codruta Miclaus
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Ovidiu Ardelean
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Marius Preda
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Octavian Mazilu
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
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Reynolds BR, McCombie S, Botha E, Hawks C, Brown M, Hayne D. Ten-year outcomes of the first 'one-stop haematuria clinic' in an Australian public hospital. ANZ J Surg 2020; 91:565-570. [PMID: 33236477 DOI: 10.1111/ans.16439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Urgent assessment of haematuria is critical to exclude malignancy. The utilization of haematuria clinics in Australia remains in its infancy. It is hoped that the streamlined investigative service will achieve earlier diagnosis of urological malignancy and subsequently decrease morbidity and mortality. We report the 10-year prospectively collected outcomes from Australia's first dedicated one-stop haematuria clinic (OSHC). METHODS Since its commencement in May 2008 through to July 2018, all consecutive patients assessed in the OSHC were included in the analysis. Data collected included demographics, presentation, wait times, investigation, assessment, initial treatment, referral and histopathology. RESULTS A total of 3008 patients were seen in the OSHC with non-visible haematuria (1024, 34%) and visible haematuria (1984, 66%). Three hundred and twenty-seven (10.9%) patients were diagnosed with urothelial malignancy. In all, 306 (10.2%) patients had lower tract disease and 21 (0.7%) had upper tract disease. Urothelial cases were compiled of 123 (37.6%) Ta LG, 39 (11.9%) Ta HG, 21 (6.4%) Tis, 67 (20.5%) T1 and 77 (23.6%) T2-4. Urothelial malignancy was diagnosed more often in males (odds ratio (OR) 1.74, 95% confidence interval (CI) 1.35-2.25), older patients elder than 60 years (OR 1.97, 95% CI 1.47-2.64) and patients with visible haematuria (OR 5.42, 95% CI 3.73-7.86). In all, 53.4% of patients were discharged after a single visit to the OSHC. CONCLUSION The OSHC has served as an effective tool for rapid, streamlined assessment of patients presenting with haematuria. This model of care has been subsequently adopted by numerous public centres across Australia. Current funding structures present a barrier to this excellent approach for rapid access diagnostics.
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Affiliation(s)
- Bradley R Reynolds
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Steve McCombie
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Erica Botha
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Cynthia Hawks
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Brown
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Dickon Hayne
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
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Raposeiras Roubín S, Abu Assi E, Barreiro Pardal C, Cespón Fernandez M, Muñoz Pousa I, Cobas Paz R, Parada JA, Represa Montenegro M, Melendo Miu M, Blanco Prieto S, Rosselló X, Ibañez B, Íñiguez Romo A. New Cancer Diagnosis After Bleeding in Anticoagulated Patients With Atrial Fibrillation. J Am Heart Assoc 2020; 9:e016836. [PMID: 33140676 PMCID: PMC7763724 DOI: 10.1161/jaha.120.016836] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/18/2020] [Indexed: 11/16/2022]
Abstract
Background Bleeding is frequent in patients with atrial fibrillation (AF) treated with oral anticoagulant therapy, and may be the first manifestation of underlying cancer. We sought to investigate to what extent bleeding represents the unmasking of an occult cancer in patients with AF treated with oral anticoagulants. Methods and Results Using data from CardioCHUVI-AF (Retrospective Observational Registry of Patients With Atrial Fibrillation From Vigo's Health Area), 8753 patients with AF aged ≥75 years with a diagnosis of AF between 2014 and 2017 were analyzed. Of them, 2171 (24.8%) experienced any clinically relevant bleeding, and 479 (5.5%) were diagnosed with cancer during a follow-up of 3 years. Among 2171 patients who experienced bleeding, 198 (9.1%) were subsequently diagnosed with cancer. Patients with bleeding have a 3-fold higher hazard of being subsequently diagnosed with new cancer compared with those without bleeding (4.7 versus 1.4 per 100 patient-years; adjusted hazard ratio [HR], 3.2 [95% CI, 2.6-3.9]). Gastrointestinal bleeding was associated with a 13-fold higher hazard of new gastrointestinal cancer diagnosis (HR, 13.4; 95% CI, 9.1-19.8); genitourinary bleeding was associated with an 18-fold higher hazard of new genitourinary cancer diagnosis (HR, 18.1; 95% CI, 12.5-26.2); and bronchopulmonary bleeding was associated with a 15-fold higher hazard of new bronchopulmonary cancer diagnosis (HR, 15.8; 95% CI, 6.0-41.3). For other bleeding (nongastrointestinal, nongenitourinary, nonbronchopulmonary), the HR for cancer was 2.3 (95% CI, 1.5-3.6). Conclusions In patients with AF treated with oral anticoagulant therapy, any gastrointestinal, genitourinary, or bronchopulmonary bleeding was associated with higher rates of new cancer diagnosis. These bleeding events should prompt investigation for cancers at those sites.
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Affiliation(s)
- Sergio Raposeiras Roubín
- Hospital Universitario Álvaro CunqueiroVigoSpain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC)MadridSpain
| | | | | | | | | | | | | | | | | | | | - Xavier Rosselló
- Centro Nacional de Investigaciones Cardiovasculares (CNIC)MadridSpain
- Department of CardiologyHealth Research Institute of the Balearic Islands (IdISBa)University Hospital Son EspasesPalmaSpain
| | - Borja Ibañez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC)MadridSpain
- Hospital Fundación Jiménez DíazMadridSpain
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9
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Jin H, Lin T, Han P, Yao Y, Zheng D, Hao J, Hu Y, Zeng R. Efficacy of Raman spectroscopy in the diagnosis of bladder cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18066. [PMID: 31764837 PMCID: PMC6882629 DOI: 10.1097/md.0000000000018066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bladder cancer is one of the severest human malignancies which are hardly detected at an early stage. Raman spectroscopy is reported to maintain a high diagnostic accuracy, sensitivity and specificity in some tumors. METHODS We carried out a complete systematic review based on articles from PubMed/Medline, EMBASE, Web of Science, Ovid, Web of Knowledge, Cochrane Library and CNKI. We identified 2341 spectra with strict criteria in 9 individual studies between 2004 and 2018 in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We summarized the test performance using random effects models. RESULTS General pooled diagnostic sensitivity and specificity of RS to kidney cancer were 94% (95% CI 0.93-0.95) and 92% (95% CI 0.90-0.93). The pooled positive LR was 10.00 (95%CI 5.66-17.65) while the negative LR was 0.09 (95%CI 0.06-0.14). The pooled DOR was 139.53 (95% CI 54.60-356.58). The AUC of SROC was 0.9717. CONCLUSION Through this meta-analysis, we found a promisingly high sensitivity and specificity of RS in the diagnosis of suspected bladder masses and tumors. Other parameters like positive, negative LR, DOR, and AUC of the SROC curve all helped to illustrate the high efficacy of RS in bladder cancer diagnosis.
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Affiliation(s)
- Hongyu Jin
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital
- West China School of Medicine
| | - Tianhai Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | | | - Rui Zeng
- West China School of Medicine
- Department of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
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