Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense C, Denmark.
BMC Cancer. 2018 Apr 18;18(1):440. doi: 10.1186/s12885-018-4376-8.
Survival rates for upper gastrointestinal (GI) cancer are poor since many are diagnosed at advanced stages. Fast track endoscopy has been introduced to prompt diagnosis for patients with alarm symptoms that could be indicative of upper GI cancer. However, these symptoms may represent benign conditions and little is known about the predictive values of alarm symptoms of upper GI cancer in the general population.
The study is a nationwide cohort study of 60,562 individuals aged 45 years or above randomly selected from the Danish general population. Participants were invited to complete a survey comprising of questions on several symptom experiences, including alarm symptoms for upper GI cancer within the past four weeks. The participants were asked about specific symptoms (repeated vomiting, difficulty swallowing, signs of upper GI bleeding or persistent and recent-onset abdominal pain) and non-specific symptoms (nausea, weight loss, loss of appetite, feeling unwell and tiredness). We obtained information on upper GI cancer diagnosed in a 12-month period after completing the questionnaire from the Danish Cancer Registry. We calculated positive predictive values and positive likelihood ratios for the association between alarm symptom and subsequent upper GI cancer.
A total of 33,040 individuals above 45 years completed the questionnaire, yielding a response rate of 54.6%. Respondents were fairly respresentative of the study sample. During the follow-up period, 18 people were diagnosed with upper GI cancer. The number of incident cancers was similar among eligible non-respondents. Two thirds of the respondents with an upper GI malignancy had experienced one or more alarm symptoms. The positive predictive value for being diagnosed with upper GI cancer after reporting a least one alarm symptom was 0.1% (95% CI:0.0-0.1%). The positive likelihood ratio was 4.4 for specific alarm symptoms and 1.1 for non-specific alarm symptoms.
We found that positive predictive values of alarm symptoms of upper GI cancer experienced in the general population are low. It is important knowledge that despite denoted alarm symptoms even patients with specific alarm symptoms of upper GI cancer have a low risk of being diagnosed with upper GI cancer.
上消化道（GI）癌症的生存率较差，因为许多癌症在晚期才被诊断出来。快速通道内镜检查已被引入，以便对有警报症状的患者进行快速诊断，这些症状可能提示上 GI 癌症。然而，这些症状可能代表良性疾病，对上消化道癌症警报症状在普通人群中的预测价值知之甚少。
该研究是一项全国性队列研究，共纳入 60562 名年龄在 45 岁或以上的丹麦普通人群。参与者被邀请完成一项包含多项症状体验问题的调查，包括过去四周内上 GI 癌症的警报症状。参与者被问到特定症状（反复呕吐、吞咽困难、上 GI 出血迹象或持续和近期出现的腹痛）和非特定症状（恶心、体重减轻、食欲不振、不适和疲倦）。我们从丹麦癌症登记处获得了在完成问卷后 12 个月内诊断出的上 GI 癌症信息。我们计算了警报症状与随后上 GI 癌症之间的阳性预测值和阳性似然比。
共有 33040 名 45 岁以上的人完成了问卷，应答率为 54.6%。应答者在研究样本中具有相当的代表性。在随访期间，有 18 人被诊断出患有上 GI 癌症。符合条件的未应答者中癌症的发病数量相似。三分之二患有上 GI 恶性肿瘤的患者经历过一种或多种警报症状。报告至少一种警报症状后被诊断为上 GI 癌症的阳性预测值为 0.1%（95%CI：0.0-0.1%）。特异性警报症状的阳性似然比为 4.4，非特异性警报症状的阳性似然比为 1.1。
我们发现上 GI 癌症警报症状在上消化道癌症普通人群中的阳性预测值较低。尽管有警报症状，但即使是上 GI 癌症的特定警报症状患者，其被诊断为上 GI 癌症的风险也较低，这是一个重要的知识。
