确定与童年，青少年和年轻成人癌症有关的早期症状：基于人群的病例对照研究
Identifying early symptoms associated with a diagnosis of childhood, adolescent and young adult cancers: a population-based nested case-control study
影响因子:6.80000
分区:医学2区 Top / 肿瘤学2区
发表日期:2024 Oct
作者:
D Saatci, J Oke, A Harnden, J Hippisley-Cox
摘要
童年，青少年和年轻人（CTYA，0 - 24年）癌症罕见且多样化，使及时诊断具有挑战性。我们旨在探索与随后的癌症诊断相关的症状和症状组合并建立时间表。使用QResearch数据库，我们进行了匹配的嵌套病例对照研究。使用条件逻辑回归探索了初级保健中遇到的预指定症状与随后诊断任何癌症之间的关联。中位诊断间隔用于将症状分为“晚期”和“早期”时间表，以识别相关的早期症状。3186例病例和50,576个对照组可从3,424,771 CTYA的队列中确定。 We identified 12 novel associations, of which hemiparesis [OR 90.9 (95%CI 24.7-335.1), PPV = 1.6%], testicular swelling [OR 186.7 (95%CI 86.1-404.8), PPV = 2.4%] and organomegaly [OR 221.6 (95%CI 28.3-1735.9), PPV = 5.4%] had显着的阳性预测值（PPV）。肢体疼痛是儿童严重疾病的已知标志物，是癌症亚型的早期症状。在整个儿童期和TYA癌症中都观察到类似的临床表现。使用迄今为止最大的队列，我们提供了有关症状在CTYA癌症诊断中的随时间变化的预测效用的新信息。我们的发现将有助于提高对症状的临床和公众意识，对高危患者进行分层，并最终帮助较早的诊断。
Abstract
Childhood, teenage and young adult (CTYA, 0-24 years) cancers are rare and diverse, making timely diagnosis challenging. We aim to explore symptoms and symptom combinations associated with a subsequent cancer diagnosis and to establish their timeframe.Using the QResearch Database, we carried out a matched nested case-control study. Associations between pre-specified symptoms encountered in primary care and a subsequent diagnosis of any cancer were explored using conditional logistic regression. Median diagnostic intervals were used to split symptoms into "late" and "early" timeframes to identify relevant early symptoms.3186 cases and 50,576 controls were identified from a cohort of 3,424,771 CTYA. We identified 12 novel associations, of which hemiparesis [OR 90.9 (95%CI 24.7-335.1), PPV = 1.6%], testicular swelling [OR 186.7 (95%CI 86.1-404.8), PPV = 2.4%] and organomegaly [OR 221.6 (95%CI 28.3-1735.9), PPV = 5.4%] had significant positive predictive values (PPV). Limb pain, a known marker of serious illness in children, was a recurrent early symptom across cancer subtypes. Similar clinical presentations were observed across childhood and TYA cancers.Using the largest cohort to date, we provide novel information on the time-varying predictive utility of symptoms in the diagnosis of CTYA cancers. Our findings will help to raise clinical and public awareness of symptoms, stratify those at higher-risk and ultimately aid earlier diagnosis.