Clinical relevance of thrombocytosis in primary care: a prospective cohort study of cancer incidence using English electronic medical records and cancer registry data
Clinical relevance of thrombocytosis in primary care: a prospective cohort study of cancer incidence using English electronic medical records and cancer registry data
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DOI：
10.3399/bjgp17x691109
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发表时间：
2017-06-01
影响因子：
5.9
通讯作者：
Hamilton, Willie
中科院分区：
文献类型：
--
作者：
Bailey, Sarah E. R.;Ukoumunne, Obioha C.;Hamilton, Willie
研究背景血小板增多症(血小板计数升高)是一种新出现的癌症危险标记物，但其相关性在初级保健中尚未被充分研究。目的检测血小板增多症患者队列中的癌症发病率，以确定该危险标记物在预测潜在恶性肿瘤方面的临床应用价值。设计和背景使用2000年至2013年的临床实践研究数据链接数据进行前瞻性队列研究。方法比较两组患者1年的癌症发病率：40,000名年龄>；=40岁，血小板计数为400×10(9)/L(血小板增多症)和10,000名匹配的血小板计数正常的患者。结果在9435名患有血小板增多症的男性中，共有1098人被诊断为癌症(11.6%；95%可信区间[CI]=11.0~12.3)，而在2599名未患血小板增多症的男性中，有106人被诊断为癌症(4.1%；95%CI=3.4~4.9)。在21826名患有血小板增多症的女性中，共有1355人罹患癌症(6.2%；95%CI=5.9~6.5)，而在5370名非血小板增多症女性中，有119人罹患癌症(2.2%；95%CI=1.8~2.6)。当血小板计数在6个月内第二次升高时，男性患癌症的风险增加到18.1%(95%CI=15.9~20.5)，女性增加到10.1%(95%CI=9.0~11.3)。肺癌和结直肠癌更常被诊断为血小板增多症。结论血小板增多症是成人癌症的危险标记物，男性和女性的癌症发病率分别为11.6%和6.2%，值得进一步研究。这些数字远远超过了国家健康与护理卓越研究所规定的3%的风险阈值，以保证对疑似癌症的转诊。
BackgroundThrombocytosis (raised platelet count) is an emerging risk marker of cancer, but the association has not been fully explored in a primary care context.AimTo examine the incidence of cancer in a cohort of patients with thrombocytosis, to determine how clinically useful this risk marker could be in predicting an underlying malignancy.Design and settingA prospective cohort study using Clinical Practice Research Datalink data from 2000 to 2013.MethodThe 1-year incidence of cancer was compared between two cohorts: 40 000 patients aged >= 40 years with a platelet count of >400 x 10(9)/L (thrombocytosis) and 10 000 matched patients with a normal platelet count. Sub-analyses examined the risk with change in platelet count, sex, age, and different cancer sites.ResultsA total of 1098 out of 9435 males with thrombocytosis were diagnosed with cancer (11.6%; 95% confidence interval [CI] = 11.0 to 12.3), compared with 106 of 2599 males without thrombocytosis (4.1%; 95% CI = 3.4 to 4.9). A total of 1355 out of 21 826 females with thrombocytosis developed cancer (6.2%; 95% CI = 5.9 to 6.5), compared with 119 of 5370 females without (2.2%; 95% CI = 1.8 to 2.6). The risk of cancer increased to 18.1% (95% CI = 15.9 to 20.5) for males and 10.1% (95% CI = 9.0 to 11.3) for females, when a second raised platelet count was recorded within 6 months. Lung and colorectal cancer were more commonly diagnosed with thrombocytosis. One-third of patients with thrombocytosis and lung or colorectal cancer had no other symptoms indicative of malignancy.ConclusionThrombocytosis is a risk marker of cancer in adults; 11.6% and 6.2% cancer incidence in males and females, respectively, is worthy of further investigation for underlying malignancy. These figures well exceed the National Institute for Health and Care Excellence-mandated risk threshold of 3% risk to warrant referral for suspected cancer.