發(fā)表在1月份的British Journal of General Practice雜志上的一項研究"Identifying patients with suspected colorectal cancer in primary care: derivation and validation of an algorithm"表明，諾丁漢大學和ClinRisk公司的研究人員已經(jīng)研發(fā)成功兩種新的QCancer算法,，這兩種算法能綜合參考病人的癥狀及危險因素為最易發(fā)展為胰腺癌和腸癌的個體提供預警，從而能幫助醫(yī)生更快的做出診斷,，這將可能在每年內挽救上千人的生命,。
這項研究的負責人,，諾丁漢大學基層醫(yī)療部的Julia Hippisley-Cox教授指出：“我們希望這些新工具能幫助那些難以早期鑒別疑似癌癥病人的家庭醫(yī)生，進而有助于使病人有更好的治療選擇并改善疾病結局,。”
胰腺癌在英國每年發(fā)病超過8000例,。在所有癌癥中，胰腺癌的生存率最低,，幾乎3/4的病人在診斷后一年內死亡,。胰腺癌的早期發(fā)現(xiàn)顯著提高病人的生存，但由于危險因素不明且缺少可靠的篩查工具,，胰腺癌也是家庭醫(yī)生最難發(fā)現(xiàn)的癌癥之一,。
研究者利用564名家庭醫(yī)生處病人的數(shù)據(jù)進行算法的研發(fā)，并根據(jù)體重減輕,，食欲不振,，腹痛等臨床癥狀以及年齡、慢性胰腺炎,、吸煙和糖尿病等危險因素進行綜合考慮,，對此算法進行驗證，成功預測了那些病人易患胰腺癌,。
在隨訪兩年期間,，此算法成功了預測了62%的胰腺癌，這些病例均來自于病人中10%的預測發(fā)病風險最高的那一部分,。結直腸癌也稱為腸癌,，在歐洲是第二最常見的癌癥，也是癌癥相關死亡的第二常見原因,。
在英國,，每年腸癌的發(fā)病和死亡人數(shù)分別為36,000和16,500。英國腸癌的生存率在歐洲最低,，一般認為主要是由于癥狀出現(xiàn)較晚,、診斷和治療的延遲?？焖俚脑缙谠\斷可以使情況大為改善,，早期診斷的患者五年生存率能高達90%。腸癌的一些主要癥狀如直腸出血,，體重減輕,，食欲不振，腹瀉,，便秘,，腹痛非常常見,，這癥狀也常見于其他不太嚴重的一些疾病，也為家庭醫(yī)生的診斷增加了困難,。（生物谷Bioon.com）
doi:10.3399/bjgp12X616346
PMC:
PMID:
Identifying patients with suspected colorectal cancer in primary care: derivation and validation of an algorithm
Hippisley-Cox, Julia; Coupland, Carol
Background
Earlier diagnosis of colorectal cancer could help improve survival so better tools are needed to help this.
Aim
To derive and validate an algorithm to quantify the absolute risk of colorectal cancer in patients in primary care with and without symptoms.
Design and setting
Cohort study using data from 375 UK QResearch® general practices for development and 189 for validation.
Method
Included patients were aged 30-84 years, free at baseline from a diagnosis of colorectal cancer and without rectal bleeding, abdominal pain, appetite loss, or weight loss in the previous 12 months. The primary outcome was incident diagnosis of colorectal cancer recorded in the next 2 years. Risk factors examined were age, body mass index, smoking status, alcohol status, deprivation, diabetes, inflammatory bowel disease, family history of gastrointestinal cancer, gastrointestinal polyp, history of another cancer, rectal bleeding, abdominal pain, abdominal distension, appetite loss, weight loss, diarrhoea, constipation, change of bowel habit, tiredness, and anaemia. Cox proportional hazards models were used to develop separate risk equations in males and females. Measures of calibration and discrimination assessed performance in the validation cohort.
Results
There were 4798 incident cases of colorectal cancer from 4.1 million person-years in the derivation cohort. Independent predictors in males and females included family history of gastrointestinal cancer, anaemia, rectal bleeding, abdominal pain, appetite loss, and weight loss. Alcohol consumption and recent change in bowel habit were also predictors in males. On validation, the algorithms explained 65% of the variation in females and 67% in males. The receiver operating curve statistics were 0.89 (females) and 0.91 (males). The D statistic was 2.8 (females) and 2.9 (males). The 10% of patients with the highest predicted risks contained 71% of all colorectal cancers diagnosed over the next 2 years
Conclusion
The algorithm has good discrimination and calibration and could potentially be used to help identify those at highest risk of current colorectal cancer, to facilitate early referral and investigation.
