Carrier Marc, Le Gal Grégoire, Wells Philip S, Fergusson Dean, Ramsay Tim, Rodger Marc A
University of Ottawa and Ottawa Health Research Institute, Ottawa, Ontario, Canada.
Ann Intern Med. 2008 Sep 2;149(5):323-33. doi: 10.7326/0003-4819-149-5-200809020-00007.
Identifying previously undiagnosed cancer in patients with newly diagnosed venous thromboembolism (VTE) is important. Screening for malignant conditions can potentially diagnose more cases of cancer and at earlier stages, thereby preventing cancer-associated morbidity and perhaps mortality.
To summarize the period prevalence of previously undiagnosed cancer at baseline (within 1 month of VTE diagnosis), 6 months, and 12 months after VTE diagnosis and to quantify the additional value of an extensive cancer screening strategy (limited screening plus imaging techniques or tumor marker measurement) at baseline compared with more limited screening (history, physical examination, and simple widely available tests) at baseline.
MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, and Evidence-Based Medicine Reviews.
A total of 36 studies that reported the prevalence of undiagnosed cancer at baseline, 6 months, and 12 months were selected. Fourteen articles and 1 abstract also met inclusion criteria for the assessment of extensive versus limited cancer screening.
Two reviewers independently extracted data onto standardized forms.
The period prevalence of previously undiagnosed cancer in patients with unprovoked VTE was 6.1% (95% CI, 5.0% to 7.1%) at baseline and 10.0% (CI, 8.6% to 11.3%) from baseline to 12 months. An extensive screening strategy using computed tomography of the abdomen and pelvis statistically significantly increased the proportion of previously undiagnosed cancer detected from 49.4% (CI, 40.2% to 58.5%) (with limited screening alone) to 69.7% (CI, 61.1% to 77.8%) in patients with unprovoked VTE.
The investigators could not determine complication rates, cost-effectiveness, and difference in morbidity and mortality associated with extensive screening strategies.
Previously undiagnosed cancer is frequent in patients with unprovoked VTE. Many cases of previously undiagnosed cancer are missed by screening. An extensive cancer screening strategy detects more malignant conditions than does a limited screening strategy.
在新诊断为静脉血栓栓塞症（VTE）的患者中识别先前未诊断出的癌症很重要。筛查恶性疾病有可能诊断出更多的癌症病例，且能在更早阶段诊断出来，从而预防与癌症相关的发病甚至可能预防死亡。
总结在基线时（VTE诊断后1个月内）、VTE诊断后6个月和12个月时先前未诊断出癌症的期间患病率，并量化与基线时更有限的筛查（病史、体格检查和简单的常用检查）相比，广泛癌症筛查策略（有限筛查加成像技术或肿瘤标志物测量）在基线时的附加价值。
MEDLINE、EMBASE、Cochrane对照试验注册库和循证医学综述。
共选择了36项报告了基线时、6个月时和12个月时未诊断出癌症患病率的研究。14篇文章和1篇摘要也符合评估广泛与有限癌症筛查的纳入标准。
两名研究者独立将数据提取到标准化表格中。
在无诱因VTE患者中，基线时先前未诊断出癌症的期间患病率为6.1%（95%CI，5.0%至7.1%），从基线到12个月为10.0%（CI，8.6%至11.3%）。在无诱因VTE患者中，使用腹部和骨盆计算机断层扫描的广泛筛查策略在统计学上显著将检测到的先前未诊断出癌症的比例从49.4%（CI，40.2%至58.5%）（仅采用有限筛查）提高到69.7%（CI，61.1%至77.8%）。
研究者无法确定与广泛筛查策略相关的并发症发生率、成本效益以及发病率和死亡率差异。
在无诱因VTE患者中，先前未诊断出的癌症很常见。许多先前未诊断出的癌症病例通过筛查会被漏诊。广泛癌症筛查策略比有限筛查策略能检测出更多的恶性疾病。
