采用症状、年龄、肿块和缺铁性贫血（SAMI）进行临床评估，以确定结直肠癌的风险。

Clinical assessment to determine the risk of bowel cancer using Symptoms, Age, Mass and Iron deficiency anaemia (SAMI).

机构信息

Department of Colorectal Surgery, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK.

Bayer Pharma AG, Berlin, Germany.

出版信息

Br J Surg. 2017 Sep;104(10):1393-1404. doi: 10.1002/bjs.10573. Epub 2017 Jun 21.

DOI:10.1002/bjs.10573

PMID:28634990

Abstract

BACKGROUND

The aim of this study was to identify characteristics with independent predictive value for bowel cancer for use in the clinical assessment of patients attending colorectal outpatient clinics.

METHODS

This was a 22-year (1986-2007) retrospective cohort analysis of data collected prospectively from patients who attended colorectal surgical outpatient clinics in Portsmouth. The data set was split randomly into two groups of patients to generate and validate a predictive model. Multivariable logistic regression was used to create and validate a system to predict outcome. Receiver operating characteristic (ROC) curves and Hosmer-Lemeshow test were used to evaluate the model's predictive capability. The likelihood of bowel cancer was expressed as the odds ratio (OR).

RESULTS

Data from 29 005 patients were analysed. Discrimination of the model for bowel cancer was high in the development (C-statistic 0·87, 95 per cent c.i. 0·85 to 0·88) and validation (C-statistic 0·86, 0·84 to 0·87) groups. The most important co-variables in the final model were: age (OR 3·17-27·10), rectal (OR 31·48) or abdominal (OR 1·83-8·45) mass, iron deficiency anaemia (IDA) (OR 4·42-8·38), rectal bleeding and change in bowel habit in combination (OR 5·37), change in bowel habit without rectal bleeding, with or without abdominal pain (OR 2·12-2·52), and rectal bleeding with no perianal symptoms and without change in bowel habit (OR 2·91). Some 91·5 per cent of bowel cancers presented with these characteristics, 40·4 per cent with a mass and/or IDA. In patients with at least one of these characteristics the overall risk of having cancer was 10·0 (range 6·5-50·4) per cent, compared with 1·1 (0·3-2·3) per cent in patients without them.

CONCLUSION

A clinical assessment that systematically identifies or excludes four symptom-age combinations, a mass and IDA (SAMI) stratifies patients as having a low and higher risk of having bowel cancer. This could improve patient selection for referral and investigation.

摘要

背景

本研究旨在确定对结直肠癌患者具有独立预测价值的特征，以便用于临床评估。

方法

这是一项 22 年（1986-2007 年）回顾性队列分析，对在朴茨茅斯肛肠外科门诊就诊的患者前瞻性收集的数据进行了分析。数据集被随机分为两组患者，以生成和验证预测模型。多变量逻辑回归用于创建和验证预测结果的系统。接收者操作特征（ROC）曲线和 Hosmer-Lemeshow 检验用于评估模型的预测能力。结直肠癌的可能性用优势比（OR）表示。

结果

对 29005 例患者的数据进行了分析。该模型对结直肠癌的区分度在开发（C 统计量 0.87，95%置信区间 0.85-0.88）和验证（C 统计量 0.86，0.84-0.87）组中均较高。最终模型中的重要协变量为：年龄（OR 3.17-27.10）、直肠（OR 31.48）或腹部（OR 1.83-8.45）肿块、缺铁性贫血（IDA）（OR 4.42-8.38）、直肠出血与排便习惯改变相结合（OR 5.37）、无直肠出血但排便习惯改变，伴或不伴腹痛（OR 2.12-2.52）、直肠出血伴无肛周症状且无排便习惯改变（OR 2.91）。91.5%的结直肠癌患者具有这些特征，40.4%的患者有肿块和/或 IDA。在至少有一个这些特征的患者中，癌症的总体风险为 10.0%（范围为 6.5-50.4%），而没有这些特征的患者为 1.1%（0.3-2.3%）。