Pattern of declining hemoglobin concentration before cancer diagnosis
Pattern of declining hemoglobin concentration before cancer diagnosis
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DOI：
10.1002/ijc.25122
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发表时间：
2010-09-15
影响因子：
6.4
通讯作者：
Nyren, Olof
中科院分区：
文献类型：
--
作者：
Edgren, Gustaf;Bagnardi, Vincenzo;Nyren, Olof
尽管贫血被广泛认为是恶性疾病的早期征兆，但在诊断前对血红蛋白下降的模式知之甚少。作为了解不同类型恶性疾病临床前阶段持续时间的一种方法，我们研究了一大群献血者的诊断前血红蛋白浓度变化。我们使用巢式病例对照设计，分析了一个由 110 万斯堪的纳维亚献血者组成的基于人群的队列，并通过与人口和癌症登记册的记录联系进行了完整的随访。总共确定了 16,375 例癌症病例，我们为其选择了 161,995 例对照。我们使用条件逻辑回归来估计癌症诊断前 5 年内与血红蛋白浓度相关的癌症风险。在诊断出胃癌、多发性骨髓瘤和淋巴白血病之前 3 年，血红蛋白浓度就开始下降；诊断小肠癌、结肠癌以及霍奇金淋巴瘤前 2 年。去年，非霍奇金淋巴瘤和骨髓/单核细胞白血病的发病率明显下降，而食道癌、乳腺癌或前列腺癌的发病率没有变化。总之，在这项研究中，我们证明了癌症诊断前血红蛋白浓度下降的模式在不同恶性肿瘤之间存在很大差异，但并不是针对其中任何一种的合适筛查工具。然而，对于某些恶性肿瘤，临床诊断前血红蛋白下降的持续时间较长，这表明具有系统性影响的较长时间，在此期间，通过新兴的诊断工具应该可以实现早期诊断。
Although anemia is widely considered an early sign of malignant disease, little is known about the pattern of hemoglobin decline before diagnosis. As an approach to understanding the duration of the preclinical phase of different types of malignant diseases, we investigated prediagnostic hemoglobin concentration changes in a large cohort of blood donors. Using a nested case-control design, we analyzed a population-based cohort comprising 1.1 million Scandinavian blood donors with complete follow-up through record linkage to population and cancer registers. A total of 16,375 cancer cases were identified, for whom we selected 161,995 controls. We used conditional logistic regression to estimate the risk of cancer in relation to hemoglobin concentration during the 5 years preceding the cancer diagnosis. Hemoglobin concentration decline began already 3 years before diagnosis of stomach cancer, multiple myeloma, and lymphatic leukemia; 2 years before diagnosis of small intestinal and colon cancer as well as of Hodgkin lymphoma. A decline was evident during the last year for non-Hodgkin lymphoma and myeloid/monocytic leukemia, whereas no change was found for cancer of the esophagus, breast or prostate. In conclusion, in this study, we have demonstrated that the pattern of declining hemoglobin concentration before cancer diagnosis varies considerably between malignancies without being a suitable screening tool for any of them. For some malignancies, however, the long duration of hemoglobin decline before clinical diagnosis suggests a substantial lead-time with systemic effects, during which earlier diagnosis should be achievable by emerging diagnostic tools.