Lurie Galina, Thompson Pamela J, McDuffie Katharine E, Carney Michael E, Goodman Marc T
Cancer Epidemiology Program, Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI 96813, USA.
Gynecol Oncol. 2009 Aug;114(2):231-6. doi: 10.1016/j.ygyno.2009.05.001. Epub 2009 May 22.
Women with ovarian carcinoma experience poor survival because symptoms are vague and diagnosis is unlikely at an early stage. The objective of this study was to identify a set of symptoms that might assist gynecologists and other clinicians in the diagnosis of localized ovarian carcinoma when treatment is most effective.
This population-based case-control study included 432 women, aged 19-88 years, with invasive ovarian carcinoma and 491 controls frequency-matched to cases on age, ethnicity, and interview time. Symptoms data were collected using interviewer-administered questionnaires. Odds ratios and 95% confidence intervals for the association of symptoms with ovarian carcinoma by stage and histology were estimated using unconditional multiple polytomous logistic regression models. The predictive ability of symptoms was evaluated by comparing the area under receiver operating curves (ROC).
The following self-reported symptoms were significantly predictive of localized ovarian carcinoma irrespective of histological type: abdominal pain (ROC=0.81), distended and hard abdomen (ROC=0.83), vaginal bleeding not associated with periods (ROC=0.88), and a palpable abdominal mass (ROC=0.88). Urinary symptoms had low predictive ability, and bowel symptoms and fatigue/loss of appetite were predictive only at advanced stages. The best predictive ability was observed for a 4-symptom index that included abdominal pain, distended and hard abdomen, abdominal mass, and abnormal vaginal bleeding (ROC=0.90 sensitivity=74%; specificity=71%).
Greater awareness of the symptoms potentially related to ovarian cancer might lead to earlier diagnosis and might improve survival.
卵巢癌女性患者生存率较低，因为症状不明确，且早期不太可能确诊。本研究的目的是确定一组症状，以帮助妇科医生和其他临床医生在治疗最有效的时候诊断局限性卵巢癌。
这项基于人群的病例对照研究纳入了432名年龄在19至88岁之间的侵袭性卵巢癌女性患者以及491名在年龄、种族和访谈时间上与病例进行频率匹配的对照者。症状数据通过访员管理的问卷收集。使用无条件多分类逻辑回归模型估计症状与不同分期和组织学类型的卵巢癌之间关联的比值比和95%置信区间。通过比较受试者工作特征曲线（ROC）下的面积来评估症状的预测能力。
以下自我报告的症状无论组织学类型如何，均对局限性卵巢癌具有显著预测性：腹痛（ROC=0.81）、腹部膨隆且硬（ROC=0.83）、非经期阴道出血（ROC=0.88）以及可触及的腹部肿块（ROC=0.88）。泌尿系统症状的预测能力较低，肠道症状以及疲劳/食欲不振仅在晚期具有预测性。对于包含腹痛、腹部膨隆且硬、腹部肿块和异常阴道出血的四项症状指数，观察到最佳预测能力（ROC=0.90；灵敏度=74%；特异度=71%）。
对可能与卵巢癌相关的症状有更高的认识可能会导致更早的诊断，并可能提高生存率。
