van Boxtel-Wilms Susan J M, van Boven Kees, Bor J H Hans, Bakx J Carel, Lucassen Peter, Oskam Sibo, van Weel Chris
a Department of Primary and Community Care , Radboud University Nijmegen Medical Centre , Nijmegen , The Netherlands ;
b Formerly of the Department of General Practice , Academic Medical Centre, University of Amsterdam , Amsterdam , the Netherlands ;
Eur J Gen Pract. 2016 Jun;22(2):91-5. doi: 10.3109/13814788.2016.1148135. Epub 2016 Mar 22.
Symptoms with a high predictive power for colorectal cancer (CRC) do not exist.
To explore the predictive value of patients' reason for encounter (RFE) in the two years prior to the diagnosis of CRC.
A retrospective nested case-control study using prospectively collected data from electronic records in general practice over 20 years. Matching was done based on age (within two years), gender and practice. The positive likelihood ratios (LR+) and odds ratios (OR) were calculated for RFE between cases and controls in the two years before the index date.
We identified 184 CRC cases and matched 366 controls. Six RFEs had significant LR + and ORs for CRC, which may have high predictive power. These RFEs are part of four chapters in the International Classification of Primary Care (ICPC) that include tiredness (significant at 3-6 months prior to the diagnosis; LR+ 2.6 and OR 3.07; and from 0 to 3 months prior to the diagnosis; LR+ 2.0 and OR 2.36), anaemia (significant at three months before diagnosis; LR+ 9.8 and OR 16.54), abdominal pain, rectal bleeding and constipation (significant at 3-6 months before diagnosis; LR+ 3.0 and OR 3.33; 3 months prior to the diagnosis LR+ 8.0 and OR 18.10) and weight loss (significant at three months before diagnosis; LR+ 14.9 and OR 14.53).
Data capture and organization in ICPC permits study of the predictive value of RFE for CRC in primary care.
不存在对结直肠癌（CRC）具有高预测力的症状。
探讨CRC诊断前两年患者就诊原因（RFE）的预测价值。
一项回顾性巢式病例对照研究，使用了20年来从全科医疗电子记录中前瞻性收集的数据。根据年龄（两年内）、性别和医疗机构进行匹配。计算了索引日期前两年病例组和对照组之间RFE的阳性似然比（LR+）和比值比（OR）。
我们确定了184例CRC病例，并匹配了366名对照。六种RFE对CRC具有显著的LR+和OR，可能具有较高的预测力。这些RFE属于国际初级保健分类（ICPC）中的四个章节，包括疲劳（在诊断前3 - 6个月显著；LR+ 2.6，OR 3.07；以及在诊断前0至3个月；LR+ 2.0，OR 2.36）、贫血（在诊断前三个月显著；LR+ 9.8，OR 16.54）、腹痛、直肠出血和便秘（在诊断前3 - 6个月显著；LR+ 3.0，OR 3.33；在诊断前3个月LR+ 8.0，OR 18.10）以及体重减轻（在诊断前三个月显著；LR+ 14.9，OR 14.53）。
ICPC中的数据采集和整理允许研究初级保健中RFE对CRC的预测价值。
