Phenotypes and rates of cancer-relevant symptoms and tests in the year before cancer diagnosis in UK Biobank and CPRD Gold.
Phenotypes and rates of cancer-relevant symptoms and tests in the year before cancer diagnosis in UK Biobank and CPRD Gold.
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DOI：
10.1371/journal.pdig.0000383
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发表时间：
2023-12
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癌症的早期诊断依赖于对出现症状的患者的癌症风险的准确评估，当筛查不合适时。但是，在癌症患者诊断前记录的症状可能会因电子健康记录（EHR）的不同来源而有所不同，无论是真正的还是由于症状记录的差异完整性。为了评估可能的差异，我们分析了与癌症登记数据相关的英国生物库和临床实践研究数据链（CPRD）人群中癌症诊断前一年的初级保健EHR。我们在Read v2和CTV 3编码系统中开发了与癌症诊断相关的21种症状和8种血液检查的协调表型。在22，601名CPRD和11，594名英国生物银行癌症患者中，分别有54%和36%的患者在诊断前一年至少有一次可能的癌症症状咨询。使用多变量泊松模型进行数据集之间的调整比较，比较CPRD中症状/测试的发生率与预期发生率，如果癌症部位-年龄-性别-剥夺相关性与UK Biobank相同。与CPRD中的患者相比，UK Biobank癌症患者因可能的癌症症状进行咨询的比率较低[RR：0.61（0.59-0.63）]，任何初级保健咨询的比率较低[RR：0.86（95%CI 0.85-0.87）]。“非报警”症状的差异较大[RR：0.54（0.52-0.56）]，而“报警”症状[RR：0.80（0.76-0.84）]和血液检查[RR：0.93（0.90-0.95）]的差异较小。在大约代表英国人口的CPRD队列中，一半的癌症患者在诊断前一年记录了症状。在英国生物库参与者中，在癌症诊断前一年记录的非特异性表现症状的频率明显较低。基于高度选择的生物库队列的结果的可推广程度需要在特定疾病的背景下进行检查。我们开发了症状表型，并描述和比较了从代表性样本和英国生物样本库中抽取的患者在癌症诊断前的症状和血液检查的比率。我们发现，在代表性样本中，约有一半的患者在癌症诊断前一年记录了症状，但英国生物银行参与者记录症状的比率要低得多。这些差异主要与非特异性症状有关，但在对癌症部位、年龄、性别和社会经济剥夺进行调整后仍然存在。我们开发的识别症状的表型可能对其他研究英国初级保健数据的研究人员有用。诊断前症状的差异强调了队列研究结果的普遍性需要在疾病特异性背景下进行检查，并支持确保公平参与主要队列研究的努力。
Early diagnosis of cancer relies on accurate assessment of cancer risk in patients presenting with symptoms, when screening is not appropriate. But recorded symptoms in cancer patients pre-diagnosis may vary between different sources of electronic health records (EHRs), either genuinely or due to differential completeness of symptom recording. To assess possible differences, we analysed primary care EHRs in the year pre-diagnosis of cancer in UK Biobank and Clinical Practice Research Datalink (CPRD) populations linked to cancer registry data. We developed harmonised phenotypes in Read v2 and CTV3 coding systems for 21 symptoms and eight blood tests relevant to cancer diagnosis. Among 22,601 CPRD and 11,594 UK Biobank cancer patients, 54% and 36%, respectively, had at least one consultation for possible cancer symptoms recorded in the year before their diagnosis. Adjusted comparisons between datasets were made using multivariable Poisson models, comparing rates of symptoms/tests in CPRD against expected rates if cancer site-age-sex-deprivation associations were the same as in UK Biobank. UK Biobank cancer patients compared with those in CPRD had lower rates of consultation for possible cancer symptoms [RR: 0.61 (0.59–0.63)], and lower rates for any primary care consultation [RR: 0.86 (95%CI 0.85–0.87)]. Differences were larger for ‘non-alarm’ symptoms [RR: 0.54 (0.52–0.56)], and smaller for ‘alarm’ symptoms [RR: 0.80 (0.76–0.84)] and blood tests [RR: 0.93 (0.90–0.95)]. In the CPRD cohort, approximately representative of the UK population, half of cancer patients had recorded symptoms in the year before diagnosis. The frequency of non-specific presenting symptoms recorded in the year pre-diagnosis of cancer was substantially lower among UK Biobank participants. The degree to which results based on highly selected biobank cohorts are generalisable needs to be examined in disease-specific contexts. We develop symptom phenotypes and describe and compare rates of symptoms and blood tests before cancer diagnosis in patients drawn from a representative sample and from UK Biobank. We found that in the representative sample around half of patients had recorded symptoms in the year before cancer diagnosis, but that rates of recorded symptoms in UK Biobank participants were substantially lower. These differences primarily related to non-specific symptoms, but remained following adjustment for cancer site, age, sex, and socio-economic deprivation. The phenotypes for identifying symptoms we developed may be useful for other researchers working with UK primary care data. The differences in pre-diagnostic symptoms emphasise that the generalisability of results from cohort studies need to be examined in a disease-specific context, and support efforts for ensuring equitable participation in major cohort studies.