School of Clinical Sciences, University of Bristol, Level 6 UHB Education Centre, Upper Maudlin Street, Bristol BS2 8AE, UK.
Br J Cancer. 2012 Feb 28;106(5):982-7. doi: 10.1038/bjc.2011.600. Epub 2012 Jan 12.
This study investigated the risk of cancer in children with alert symptoms identified in current UK guidance, or with increased consultation frequency in primary care.
A population-based, nested case-control study used data from the General Practice Research Database. In all, 1267 children age 0-14 years diagnosed with childhood cancer were matched to 15,318 controls. Likelihood ratios and positive predictive values (PPVs) were calculated to assess risk.
Alert symptoms recorded in the 12 and 3 months before diagnosis were present in 33.7% and 27.0% of cases vs 5.4% and 1.4% of controls, respectively. The PPV of having cancer for any alert symptom in the 3 months before diagnosis was 0.55 per 1000 children. Cases consulted more frequently particularly in the 3 months before diagnosis (86% cases vs 41% controls). Of these, 36% of cases and 9% of controls had consulted 4 times or more. The PPV for cancer in a child consulting 4 times or more in 3 months was 0.13 per 1000 children.
Alert symptoms and frequent consultations are associated with childhood cancer. However, individual symptoms and consultation patterns have very low PPVs for cancer in primary care (e.g., of 10,000 children with a recorded alert symptom, approximately 6 would be diagnosed with cancer within 3 months).
本研究调查了当前英国指南中确定的有警报症状的儿童或在初级保健中增加就诊频率的儿童的癌症风险。
一项基于人群的巢式病例对照研究使用了一般实践研究数据库的数据。共有 1267 名 0-14 岁的儿童被诊断为儿童癌症，与 15318 名对照匹配。计算了似然比和阳性预测值 (PPV) 来评估风险。
在诊断前 12 个月和 3 个月记录的警报症状分别在 33.7%和 27.0%的病例中出现，而在 5.4%和 1.4%的对照中出现，在诊断前 3 个月任何警报症状的 PPV 为每 1000 名儿童 0.55 例。病例就诊频率更高，尤其是在诊断前 3 个月（86%的病例 vs 41%的对照）。其中，36%的病例和 9%的对照就诊次数达到 4 次或以上。在 3 个月内就诊 4 次或以上的儿童癌症的 PPV 为每 1000 名儿童 0.13 例。
警报症状和频繁就诊与儿童癌症相关。然而，单个症状和就诊模式在初级保健中对癌症的 PPV 非常低（例如，在记录有警报症状的 10000 名儿童中，约有 6 名儿童在 3 个月内被诊断为癌症）。
