初级保健中肾癌的临床特征：一项基于初级保健记录的病例对照研究。
Clinical features of kidney cancer in primary care: a case-control study using primary care records.
机构信息
University of Exeter Medical School, Exeter, UK.
出版信息
Br J Gen Pract. 2013 Apr;63(609):e250-5. doi: 10.3399/bjgp13X665215.
BACKGROUND
Kidney cancer accounts for over 4000 UK deaths annually, and is one of the cancer sites with a poor mortality record compared with Europe.
AIM
To identify and quantify all clinical features of kidney cancer in primary care.
DESIGN
Case-control study, using General Practice Research Database records.
METHOD
A total of 3149 patients aged ≥40 years, diagnosed with kidney cancer between 2000 and 2009, and 14 091 age, sex and practice-matched controls, were selected. Clinical features associated with kidney cancer were identified, and analysed using conditional logistic regression. Positive predictive values for features of kidney cancer were estimated.
RESULTS
Cases consulted more frequently than controls in the year before diagnosis: median 16 consultations (interquartile range 10-25) versus 8 (4-15): P<0.001. Fifteen features were independently associated with kidney cancer: visible haematuria, odds ratio 37 (95% confidence interval [CI] = 28 to 49), abdominal pain 2.8 (95% CI = 2.4 to 3.4), microcytosis 2.6 (95% CI = 1.9 to 3.4), raised inflammatory markers 2.4 (95% CI = 2.1 to 2.8), thrombocytosis 2.2 (95% CI = 1.7 to 2.7), low haemoglobin 1.9 (95% CI = 1.6 to 2.2), urinary tract infection 1.8 (95% CI = 1.5 to 2.1), nausea 1.8 (95% CI = 1.4 to 2.3), raised creatinine 1.7 (95% CI = 1.5 to 2.0), leukocytosis 1.5 (95% CI = 1.2 to 1.9), fatigue 1.5 (95% CI = 1.2 to 1.9), constipation 1.4 (95% CI = 1.1 to 1.7), back pain 1.4 (95% CI = 1.2 to 1.7), abnormal liver function 1.3 (95% CI = 1.2 to 1.5), and raised blood sugar 1.2 (95% CI = 1.1 to 1.4). The positive predictive value for visible haematuria in patients aged ≥60 years was 1.0% (95% CI = 0.8 to 1.3).
CONCLUSION
Visible haematuria is the commonest and most powerful single predictor of kidney cancer, and the risk rises when additional symptoms are present. When considered alongside the risk of bladder cancer, the overall risk of urinary tract cancer from haematuria warrants referral.
背景
在英国，每年有超过 4000 人死于肾癌，其死亡率在欧洲各国中处于较低水平。
目的
确定并量化初级保健中所有肾癌的临床特征。
设计
病例对照研究，使用全科医学研究数据库记录。
方法
共纳入 3149 名年龄≥40 岁、2000 年至 2009 年间诊断为肾癌的患者，以及 14091 名年龄、性别和实践匹配的对照组。识别与肾癌相关的临床特征，并使用条件逻辑回归进行分析。估计肾癌特征的阳性预测值。
结果
与对照组相比，病例组在诊断前一年的就诊次数更多：中位数为 16 次（四分位间距为 10-25）与 8 次（4-15）：P<0.001。15 个特征与肾癌独立相关：肉眼血尿，优势比 37（95%置信区间 [CI] = 28 至 49），腹痛 2.8（95% CI = 2.4 至 3.4），微细胞性贫血 2.6（95% CI = 1.9 至 3.4），炎症标志物升高 2.4（95% CI = 2.1 至 2.8），血小板增多 2.2（95% CI = 1.7 至 2.7），低血红蛋白 1.9（95% CI = 1.6 至 2.2），尿路感染 1.8（95% CI = 1.5 至 2.1），恶心 1.8（95% CI = 1.4 至 2.3），肌酐升高 1.7（95% CI = 1.5 至 2.0），白细胞增多 1.5（95% CI = 1.2 至 1.9），疲劳 1.5（95% CI = 1.2 至 1.9），便秘 1.4（95% CI = 1.1 至 1.7），背痛 1.4（95% CI = 1.2 至 1.7），肝功能异常 1.3（95% CI = 1.2 至 1.5），血糖升高 1.2（95% CI = 1.1 至 1.4）。年龄≥60 岁患者肉眼血尿的阳性预测值为 1.0%（95% CI = 0.8 至 1.3）。
结论
肉眼血尿是肾癌最常见且最有力的单一预测指标，当存在其他症状时，风险会增加。当与膀胱癌的风险一起考虑时，血尿引起的整个尿路癌的总体风险值得转诊。
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