Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study
Presenting symptoms of cancer and stage at diagnosis: evidence from a cross-sectional, population-based study
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DOI：
10.1016/s1470-2045(19)30595-9
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发表时间：
2020-01-01
期刊：
影响因子：
51.1
通讯作者：
Lyratzopoulos, Georgios
中科院分区：
文献类型：
--
作者：
Koo, Minjoung Monica;Swann, Ruth;Lyratzopoulos, Georgios
背景早期诊断干预措施，如症状意识宣传活动，日益成为全球癌症控制战略的一部分。然而，如果目标症状代表疾病的晚期，这些策略在改善癌症预后方面效果不大。方法在这项横断面研究中，我们分析了来自2014年英国国家癌症诊断审计的人群水平的数据，这些患者患有12种实体肿瘤(膀胱癌、乳腺癌、结肠癌、子宫内膜癌、喉癌、肺癌、黑色素瘤、口腔或口咽癌、卵巢癌、前列腺癌、直肠癌和肾癌)中的一种。我们考虑了20种常见的表现症状，并用Logistic回归分析了它们与诊断时分期(TNM IV期与I-III期)的关系。对于每一种症状，我们估计了当报告为单一表现症状时以及与其他症状一起报告时的相关性。被诊断为IV期癌症的患者的比例因症状而异，从异常葡萄胎的1%(95%可信区间1~3；584例患者中的8例)到颈部肿块的80%(71~87例；105例患者中的84例)。被检查的三种症状(颈部肿块、胸痛和背痛)无论是单独报告还是与其他症状一起报告，都与IV期癌症的风险增加有关，而对于异常葡萄胎、乳房肿块、绝经后出血和直肠出血则相反。20种症状中的13种(异常葡萄胎、乳房肿块、绝经后出血、直肠出血、下尿路症状、血尿、排便习惯改变、声音嘶哑、乏力、腹痛、下腹痛、体重减轻和“任何其他症状”)中，超过50%的患者是在IV期以外的其他阶段诊断的；对于所研究的20种症状中的19种(除颈部肿块外)，超过三分之一的患者是在第四阶段以外的阶段被诊断出来的。解释尽管特定的表现症状与晚期诊断的相关性比其他症状更强，但对于大多数症状，很大一部分患者是在第四阶段以外的阶段被诊断出来的。这些发现为针对常见癌症症状的早期诊断干预提供了支持，消除了人们对他们可能只是在加速检测晚期疾病的担忧。版权所有(C)2019作者(S)。爱思唯尔有限公司出版。
Background Early diagnosis interventions such as symptom awareness campaigns increasingly form part of global cancer control strategies. However, these strategies will have little impact in improving cancer outcomes if the targeted symptoms represent advanced stage of disease. Therefore, we aimed to examine associations between common presenting symptoms of cancer and stage at diagnosis.Methods In this cross-sectional study, we analysed population-level data from the English National Cancer Diagnosis Audit 2014 for patients aged 25 years and older with one of 12 types of solid tumours (bladder, breast, colon, endometrial, laryngeal, lung, melanoma, oral or oropharyngeal, ovarian, prostate, rectal, and renal cancer). We considered 20 common presenting symptoms and examined their associations with stage at diagnosis (TNM stage IV vs stage I-III) using logistic regression. For each symptom, we estimated these associations when reported as a single presenting symptom and when reported together with other symptoms.Findings We analysed data for 7997 patients. The proportion of patients diagnosed with stage IV cancer varied substantially by presenting symptom, from 1% (95% CI 1-3; eight of 584 patients) for abnormal mole to 80% (71-87; 84 of 105 patients) for neck lump. Three of the examined symptoms (neck lump, chest pain, and back pain) were consistently associated with increased odds of stage IV cancer, whether reported alone or with other symptoms, whereas the opposite was true for abnormal mole, breast lump, postmenopausal bleeding, and rectal bleeding. For 13 of the 20 symptoms (abnormal mole, breast lump, post-menopausal bleeding, rectal bleeding, lower urinary tract symptoms, haematuria, change in bowel habit, hoarseness, fatigue, abdominal pain, lower abdominal pain, weight loss, and the "any other symptom" category), more than 50% of patients were diagnosed at stages other than stage IV; for 19 of the 20 studied symptoms (all except for neck lump), more than a third of patients were diagnosed at stages other than stage IV.Interpretation Despite specific presenting symptoms being more strongly associated with advanced stage at diagnosis than others, for most symptoms, large proportions of patients are diagnosed at stages other than stage IV. These findings provide support for early diagnosis interventions targeting common cancer symptoms, countering concerns that they might be simply expediting the detection of advanced stage disease. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.