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目的根据初级保健中的研究,评价在大规模人群中预警症状与随后的恶性肿瘤诊断之间的关系。设计队列研究。地点英国全科医疗机构研究数据库。患者 1994至2000年间在英国128家全科医疗机构注册的762325名年龄在15岁及以上的患者。既往无恶性肿瘤病史,首次出现血尿、咯血、吞咽困难或直肠出血症状。结局评估指标首次出现的血尿、咯血、吞咽困难或直肠出血症状,自症状出现3年内,在泌尿道、呼吸道、食管、结肠以及直肠等部位恶性肿瘤诊断中的阳性预测值。同时评价其似然比和敏感性。结果在11108名首发血尿患者中,有472名男性和162名女性新近诊断泌尿道恶性肿瘤,总的3年阳性预测值男性为7.4%(95%可信区间为6.8%～8.1%),女性为3.4%(2.9%～4.0%)。在4812名首发咯血患者中,有220名男性(阳性预测值7.5%,6.6%～8.5%)和81名女性(4.3%,3.4%～5.3%)诊断呼吸道恶性肿瘤。5999名首次出现吞咽困难的患者中,食管恶性肿瘤诊断在男性有150人(阳性预测值5.7%,4.9%～6.7%),女性有81人(2.4%,1.9%～3.0%)。在15289名首发直肠出血症状的患者中,则有184名男性(阳性预测值2.4%,2.1%～2.8%)和154名女性(2.0%,1.7%～2.3%)诊断结直肠恶性肿瘤。预测值随着患者年龄的增加而增加,而且值非常高,例如,年龄在75～84岁的男性咯血患者(17.1%,13.5%～21.1%)和年龄在65～74岁的男性吞咽困难患者(9.0%,6.8%～11.7%)。结论首次出现预警症状时恶性肿瘤诊断可能性增加,尤其在男性及年龄大于65岁的患者人群中。这些数据显示,对于预警症状进行早期评价有助于在早期或易于处理的阶段发现或鉴别恶性肿瘤。
Objectives To evaluate the relationship between early warning symptoms and the subsequent diagnosis of malignant tumors in a large population based on studies in primary care. Design a cohort study. Location British General Practice Research Database. Of 762,225 patients aged 15 years and older who were registered with 128 general medical institutions in the United Kingdom between 1994 and 2000. No past history of malignancy, the first occurrence of hematuria, hemoptysis, dysphagia or rectal bleeding symptoms. Outcome Measures The first occurrence of haematuria, hemoptysis, dysphagia or rectal bleeding symptoms, a positive predictive value in the diagnosis of malignant tumors in the urinary tract, respiratory tract, esophagus, colon, and rectum since the onset of symptoms within 3 years. At the same time evaluate the likelihood ratio and sensitivity. Results Among 11,108 first-episode hematuria patients, 472 men and 162 women newly diagnosed with urinary tract malignancy had a total 3-year positive predictive value of 7.4% for males (95% confidence interval 6.8% to 8.1%), females 3.4% (2.9% ~ 4.0%). Among 4812 patients with first-episode hemoptysis, 220 (7.5%, 6.6% -8.5%) and 81 women (4.3%, 3.4% -5.3%) had a diagnosis of respiratory malignancy. Of the 5999 first-time patients with dysphagia, the diagnosis of esophageal cancer was 150 in men (positive predictive value 5.7%, 4.9% -6.7%) and 81 (2.4%, 1.9% -3.0%) women. Of the 15,289 first-episode rectal bleeding patients, 184 men (positive predictive value 2.4%, 2.1% -2.8%) and 154 women (2.0%, 1.7% -2.3%) diagnosed colorectal malignancies. Predictors increase with patient age and are very high, for example, in men with hemoptysis (17.1%, 13.5% -21.1%) aged 75-84 years and those with dysphagia aged 65-74 years (9.0%, 6.8% ~ 11.7%). Conclusions The diagnosis of malignant tumors increases with the first warning signs, especially in men and in patients older than 65 years. These data suggest that early evaluation of early warning symptoms can help detect or identify malignancies at an early stage or at a manageable stage.