The risk of colorectal cancer with symptoms at different ages and between the sexes: a case-control study.
The risk of colorectal cancer with symptoms at different ages and between the sexes: a case-control study.
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DOI：
10.1186/1741-7015-7-17
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发表时间：
2009-04-17
期刊：
影响因子：
9.3
通讯作者：
Marshall T
中科院分区：
文献类型：
--
作者：
Hamilton W;Lancashire R;Sharp D;Peters TJ;Cheng K;Marshall T
结直肠癌通常在症状出现后被诊断为初级保健。虽然癌症的表现特征得到了很好的描述，但它们所带来的风险却鲜为人知。这项研究旨在量化不同症状、不同年龄组和不同性别的癌症风险。这是一项病例对照研究，使用大型电子初级保健数据库中的既存记录。病例为2001年1月至2006年7月期间诊断为结直肠癌的30岁或30岁以上的患者，按年龄、性别和实践与7名对照组相匹配。确定诊断前2年内记录的结直肠癌的所有特征。使用多变量条件logistic回归确定与癌症独立相关的特征，并量化其癌症风险。我们确定了5477例病例，38,314例年龄、性别和实践匹配的对照。六个症状和两个异常的调查（贫血和小红细胞）独立相关的结直肠癌。症状的阳性预测值为：直肠出血，≥ 80岁男性阳性预测值为4.5%（95%置信区间3.5，5.9）;排便习惯改变3.9%（2.8，5.5）;体重减轻0.8%（0.5，1.3）;腹痛1.2%（1.0，1.4）;腹泻1.2%（1.0，1.5）和便秘0.7%（0.6，0.8）。女性和年轻患者的阳性预测值较低。只有27%的患者报告了两种高危症状中的任何一种。大多数有症状的结直肠癌只出现低风险症状。需要找到一种方法，从大量出现这种症状的人中识别出那些患癌症风险最高的人。
Colorectal cancer is generally diagnosed following a symptomatic presentation to primary care. Although the presenting features of the cancer are well described, the risks they convey are less well known. This study aimed to quantify the risk of cancer for different symptoms, across age groups and in both sexes. This was a case-control study using pre-existing records in a large electronic primary care database. Cases were patients aged 30 years or older with a diagnosis of colorectal cancer between January 2001 and July 2006, matched to seven controls by age, sex and practice. All features of colorectal cancer recorded in the 2 years before diagnosis were identified. Features independently associated with cancer were identified using multivariable conditional logistic regression, and their risk of cancer quantified. We identified 5477 cases, with 38,314 age, sex and practice-matched controls. Six symptoms and two abnormal investigations (anaemia and microcytosis) were independently associated with colorectal cancer. The positive predictive values of symptoms were: rectal bleeding, positive predictive value for a male aged ≥ 80 years 4.5% (95% confidence interval 3.5, 5.9); change in bowel habit 3.9% (2.8, 5.5); weight loss 0.8% (0.5, 1.3); abdominal pain 1.2% (1.0, 1.4); diarrhoea 1.2% (1.0, 1.5) and constipation 0.7% (0.6, 0.8). Positive predictive values were lower in females and younger patients. Only 27% of patients had reported either of the two higher risk symptoms. Most symptomatic colorectal cancers present with only a low-risk symptom. There is a need to find a method of identifying those at highest risk of cancer from the large number presenting with such symptoms.
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影响因子：
105.7
作者：
Steele, RJC
通讯作者：
Steele, RJC
影响因子：
6.7
作者：
CURLESS, R;FRENCH, JM;JAMES, OFW
通讯作者：
JAMES, OFW
诊断前结直肠癌的临床特征：一项基于人群的病例对照研究。
影响因子：
8.8
作者：
Hamilton, W;Round, A;Sharp, D;Peters, TJ
通讯作者：
Peters, TJ
影响因子：
8.8
作者：
Hamilton, W.;Lancashire, R.;Marshall, T.
通讯作者：
Marshall, T.
对大肠癌诊断前院前延迟的影响：系统评价。
影响因子：
8.8
作者：
Mitchell, E.;Macdonald, S.;Campbell, N. C.;Weller, D.;Macleod, U.
通讯作者：
Macleod, U.