Vine Marilyn F, Calingaert Brian, Berchuck Andrew, Schildkraut Joellen M
Cancer Prevention, Detection and Control Research Program, Box 2949, Duke University Medical Center, Durham, NC 27710, USA.
Gynecol Oncol. 2003 Jul;90(1):75-82. doi: 10.1016/s0090-8258(03)00175-6.
The goal of this study was to characterize types, frequency, combinations, and relative onset of symptoms among ovarian cancer cases and controls.
Participants were from an ongoing, population-based, case-control study of primary epithelial ovarian cancer in a 48-country region of North Carolina. Incident cases (N = 267), aged 20-74, were identified by area hospitals on a rapid case ascertainment basis between April 1999 and March 2001. Population-based controls, with at least one intact ovary, frequency matched on age and race, were identified using random-digit dialing (N = 287) and Health Care Financing Administration (HCFA) phone lists (N = 30). Trained nurse-interviewers, using a standardized questionnaire, asked participants about specific symptoms experienced for at least 2 weeks in the year prior to diagnosis (cases)/interview (controls).
More than 90% of cases reported at least one symptom and symptoms were most often the reason for the doctor visit leading to diagnosis (74%), followed by routine examination (12%). Among invasive cases, symptoms with onsets longer before diagnosis (median 5-7 months) included gas/nausea/indigestion; urinary frequency/urgency; bowel irregularity; abnormal menstrual/vaginal bleeding or discharge; pain during intercourse; and ongoing fatigue. Symptoms with onsets closer to diagnosis (median of 2-4 months) included distended/hard abdomen; bloating/feeling of fullness; unexplained weight gain/loss; pelvic/abdominal discomfort; chest pain/respiratory difficulties; and "other" symptoms. Controls reported fewer symptoms than cases (median 1 vs 5 or 6). Control symptoms were of longer duration and much less likely to occur in combination.
Earlier diagnosis of ovarian cancer may be possible if women and physicians recognize the importance of combinations of seemingly unrelated symptoms, especially those identified as occurring longer before diagnosis.
本研究的目的是描述卵巢癌病例和对照中症状的类型、频率、组合及相对发作时间。
参与者来自北卡罗来纳州48个县正在进行的一项基于人群的原发性上皮性卵巢癌病例对照研究。1999年4月至2001年3月期间，地区医院在快速病例确诊的基础上识别出年龄在20 - 74岁之间的新发病例（N = 267）。通过随机数字拨号（N = 287）和医疗保健财务管理局（HCFA）电话清单（N = 30）识别出至少有一个完整卵巢、年龄和种族频率匹配的基于人群的对照。经过培训的护士访谈员使用标准化问卷询问参与者在诊断前一年（病例组）/访谈时（对照组）至少持续2周的特定症状。
超过90%的病例报告了至少一种症状，症状最常是导致就诊并确诊的原因（74%），其次是常规检查（12%）。在浸润性病例中，诊断前发作时间较长（中位时间5 - 7个月）的症状包括腹胀/恶心/消化不良；尿频/尿急；肠道功能紊乱；月经/阴道异常出血或分泌物；性交疼痛；以及持续疲劳。诊断前发作时间较近（中位时间2 - 4个月）的症状包括腹部膨胀/坚硬；腹胀/饱腹感；不明原因的体重增加/减轻；盆腔/腹部不适；胸痛/呼吸困难；以及“其他”症状。对照组报告的症状比病例组少（中位症状数为1对5或6）。对照的症状持续时间更长，且组合出现的可能性小得多。
如果女性和医生认识到看似无关的症状组合的重要性，尤其是那些在诊断前较长时间出现的症状，那么卵巢癌的早期诊断可能是可行的。
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