Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Medical School, University of Exeter, Exeter, UK.
Br J Cancer. 2021 Apr;124(9):1540-1542. doi: 10.1038/s41416-021-01282-4. Epub 2021 Feb 9.
Combinations of inflammatory markers are used as prognostic scores in cancer patients with cachexia. We investigated whether they could also be used to prioritise patients attending primary care with unexpected weight loss for cancer investigation.
We used English primary care electronic health records data linked to cancer registry data from 12,024 patients with coded unexpected weight loss. For each individual inflammatory marker and score we estimated the sensitivity, specificity, likelihood ratios, positive predictive value (PPV) and the area under the curve along with 95% confidence intervals for a cancer diagnosis within six months.
The risk of cancer associated with two abnormal inflammatory markers combined in a score was higher than the risk associated with individual inflammatory marker abnormalities. However, the risk of cancer in weight loss associated with individual abnormalities, notably a raised C-reactive protein, was sufficient to trigger further investigation for cancer under current NICE guidelines.
If scores including pairs of inflammatory marker abnormalities were to be used, in preference to individual abnormalities, fewer people would be investigated to diagnose one cancer with fewer false positives, but fewer people with cancer would be diagnosed overall.
在患有恶病质的癌症患者中，炎症标志物的组合被用作预后评分。我们研究了它们是否也可用于优先安排因意外体重减轻而到初级保健就诊的患者进行癌症检查。
我们使用了来自 12024 名编码意外体重减轻的患者的英国初级保健电子健康记录数据，并与癌症登记数据相关联。对于每个单独的炎症标志物和评分，我们估计了在六个月内诊断出癌症的敏感性、特异性、似然比、阳性预测值（PPV）和曲线下面积，以及 95%置信区间。
与单个炎症标志物异常相比，两个异常炎症标志物联合评分与癌症相关的风险更高。然而，与个体异常相关的体重减轻的癌症风险，尤其是 C 反应蛋白升高，足以根据当前 NICE 指南触发对癌症的进一步调查。
如果要使用包括两个炎症标志物异常的评分，而不是单个异常，那么诊断一种癌症的调查人数会减少，假阳性率会降低，但总体上诊断出的癌症患者会减少。
