识别出现非特异性腹部症状的潜在癌症患者是一项挑战。普通血液检测广泛用于初级保健中调查这些症状，但其在这种情况下检测癌症的预测价值尚不清楚。我们量化了 19 项异常血液检测结果的预测价值，以检测出现 2 种非特异性腹部症状的患者的潜在癌症。使用来自英国临床实践研究数据链 (CPRD) 的数据，这些数据与国家癌症登记处、医院发病统计数据和多重指数相关我们对 2007 年 1 月至 2016 年 10 月期间因腹痛或腹胀而到英国全科医生就诊的 30 岁以上患者进行了一项基于人群的队列研究。癌症诊断的阳性和阴性预测值（PPV 和 NPV）、敏感性和特异性（总体和按癌症部位）针对 3 个月内在初级保健中同时出现的腹痛或腹胀表现的 19 项异常血液检查结果进行了计算。就诊后 12 个月内，共有 9,427/425,549 (2.2%) 名腹痛患者和 1,148/52,321 (2.2%) 名腹胀患者被诊断患有癌症。对于这两种症状，在 60 岁以上的男性和女性中，癌症的 PPV 超过了英国国家健康与护理卓越研究所所使用的建议紧急专科癌症转诊的 3% 风险阈值。三分之二的患者同时进行了血液检查（64% 患有腹痛，70% 患有腹胀）。在 30 至 59 岁的患者中，多种血液异常使患者的癌症风险高于 3% 阈值：例如，在 50 至 59 岁患有腹胀的女性中，验血前的癌症风险从 1.6% 增加到：铁蛋白升高，9% 白蛋白低，8% 血小板升高，6% 炎症标志物升高，4% 贫血。与仅基于症状、年龄和性别的风险评估相比，对于每 1,000 名腹胀患者，结合血液检测结果信息的评估将导致 63 名额外的紧急疑似癌症转诊，并通过此途径识别出 3 名额外的癌症患者（a癌症诊断率相对提高 16%）。研究的局限性包括依赖于初级保健记录中症状编码的完整性，以及如果外推到血液检测使用率较高或较低的医疗机构，PPV 可能会出现变化。在出现非特异性腹部症状的患者中，根据症状评估癌症风险通过考虑常见血液检查结果中的附加信息，仅年龄和性别就可以大大提高。因腹痛或腹胀而到初级保健就诊的年龄≥60 岁的男性和女性患者需要考虑紧急癌症转诊或检查。对于 30 至 59 岁同时血液检查异常的患者，还应考虑进一步的癌症评估。这种方法可以通过快速转诊路线检测更多患有潜在癌症的患者，并可以指导针对不同癌症部位的专家转诊和调查策略的决策。版权所有：© 2024 Rafiq 等人。这是一篇根据知识共享署名许可条款分发的开放获取文章，允许在任何媒体上不受限制地使用、分发和复制，前提是注明原始作者和来源。

Identifying patients presenting with nonspecific abdominal symptoms who have underlying cancer is a challenge. Common blood tests are widely used to investigate these symptoms in primary care, but their predictive value for detecting cancer in this context is unknown. We quantify the predictive value of 19 abnormal blood test results for detecting underlying cancer in patients presenting with 2 nonspecific abdominal symptoms.Using data from the UK Clinical Practice Research Datalink (CPRD) linked to the National Cancer Registry, Hospital Episode Statistics and Index of Multiple Deprivation, we conducted a population-based cohort study of patients aged ≥30 presenting to English general practice with abdominal pain or bloating between January 2007 and October 2016. Positive and negative predictive values (PPV and NPV), sensitivity, and specificity for cancer diagnosis (overall and by cancer site) were calculated for 19 abnormal blood test results co-occurring in primary care within 3 months of abdominal pain or bloating presentations. A total of 9,427/425,549 (2.2%) patients with abdominal pain and 1,148/52,321 (2.2%) with abdominal bloating were diagnosed with cancer within 12 months post-presentation. For both symptoms, in both males and females aged ≥60, the PPV for cancer exceeded the 3% risk threshold used by the UK National Institute for Health and Care Excellence for recommending urgent specialist cancer referral. Concurrent blood tests were performed in two thirds of all patients (64% with abdominal pain and 70% with bloating). In patients aged 30 to 59, several blood abnormalities updated a patient's cancer risk to above the 3% threshold: For example, in females aged 50 to 59 with abdominal bloating, pre-blood test cancer risk of 1.6% increased to: 10% with raised ferritin, 9% with low albumin, 8% with raised platelets, 6% with raised inflammatory markers, and 4% with anaemia. Compared to risk assessment solely based on presenting symptom, age and sex, for every 1,000 patients with abdominal bloating, assessment incorporating information from blood test results would result in 63 additional urgent suspected cancer referrals and would identify 3 extra cancer patients through this route (a 16% relative increase in cancer diagnosis yield). Study limitations include reliance on completeness of coding of symptoms in primary care records and possible variation in PPVs if extrapolated to healthcare settings with higher or lower rates of blood test use.In patients consulting with nonspecific abdominal symptoms, the assessment of cancer risk based on symptoms, age and sex alone can be substantially enhanced by considering additional information from common blood test results. Male and female patients aged ≥60 presenting to primary care with abdominal pain or bloating warrant consideration for urgent cancer referral or investigation. Further cancer assessment should also be considered in patients aged 30 to 59 with concurrent blood test abnormalities. This approach can detect additional patients with underlying cancer through expedited referral routes and can guide decisions on specialist referrals and investigation strategies for different cancer sites.Copyright: © 2024 Rafiq et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.