University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, United Kingdom.
College of Medicine and Health, University of Exeter, College House, St Luke's Campus, Exeter, United Kingdom.
Fam Pract. 2022 May 28;39(3):354-359. doi: 10.1093/fampra/cmab153.
Cancers of the nasopharynx, nasal cavity, and accessory sinuses ("sinonasal") are rare in England, with around 750 patients diagnosed annually. There are no specific National Institute for Health and Care Excellence (NICE) referral guidelines for these cancers and no primary care research published.
To identify and quantify clinical features of sinonasal cancer in UK primary care patients.
This matched case-control study used UK Clinical Practice Research Datalink (CPRD) data. Patients were aged ≥40 years with a diagnosis of sinonasal cancer between January 1, 2000 and December 31, 2009 and had consulted their GP in the year before diagnosis. Clinical features of sinonasal cancer were analysed using conditional logistic regression. Positive predictive values (PPVs) for single and combined features were calculated.
In total, 155 cases and 697 controls were studied. Nine symptoms and one abnormal investigation were significantly associated with the cancer: nasal mass; odds ratio, 95 (95% confidence interval 7.0, 1315, P = 0.001); head and neck lumps, 68 (12, 387, P < 0.001); epistaxis, 17 (3.9, 70, P < 0.001); rhinorrhoea, 14 (4.6, 44, P < 0.001); visual disturbance, 12 (2.2, 67, P = 0.004); sinusitis, 7.3 (2.2, 25, P = 0.001); sore throat, 6.0 (2.0, 18, P = 0.001); otalgia, 5.4 (1.6, 18, P = 0.007); headache, 3.6 (1.4, 9.5, P = 0.01); raised white cell count, 8.5 (2.8, 27, P < 0.001). Combined PPVs for epistaxis/rhinorrhoea, epistaxis/sinusitis, and rhinorrhoea/sinusitis were 0.62%.
This is the first primary care study identifying epistaxis, sinusitis, and rhinorrhoea as part of the clinical prodrome of sinonasal cancer. Although no PPVs meet the 3% NICE referral threshold, these results may help clinicians identify who warrants safety-netting and possible specialist referral, potentially reducing the number of advanced-stage diagnoses of sinonasal cancer.
在英格兰，鼻咽癌、鼻腔和副鼻窦（“鼻-鼻窦”）癌症的发病率较低，每年约有 750 名患者被确诊。目前尚无针对这些癌症的英国国家卫生与保健优化研究所（NICE）特定转诊指南，也没有发表过初级保健研究。
确定并量化英国初级保健患者中鼻-鼻窦癌症的临床特征。
本匹配病例对照研究使用了英国临床实践研究数据库（CPRD）的数据。患者年龄≥40 岁，在 2000 年 1 月 1 日至 2009 年 12 月 31 日期间被诊断患有鼻-鼻窦癌，且在诊断前一年曾就诊于他们的全科医生。使用条件逻辑回归分析鼻-鼻窦癌症的临床特征。计算了单一和联合特征的阳性预测值（PPV）。
共纳入了 155 例病例和 697 例对照。有 9 种症状和 1 种异常检查结果与癌症显著相关：鼻部肿块；比值比，95（95%置信区间 7.0，1315，P=0.001）；头颈部肿块，68（12，387，P＜0.001）；鼻出血，17（3.9，70，P＜0.001）；流涕，14（4.6，44，P＜0.001）；视力障碍，12（2.2，67，P=0.004）；鼻窦炎，7.3（2.2，25，P=0.001）；咽痛，6.0（2.0，18，P=0.001）；耳痛，5.4（1.6，18，P=0.007）；头痛，3.6（1.4，9.5，P=0.01）；白细胞计数升高，8.5（2.8，27，P＜0.001）。鼻出血/流涕、鼻出血/鼻窦炎和流涕/鼻窦炎联合的 PPV 分别为 0.62%。
这是第一项确定鼻出血、鼻窦炎和流涕是鼻-鼻窦癌临床前驱期一部分的初级保健研究。虽然没有任何 PPV 达到 NICE 3%的转诊阈值，但这些结果可能有助于临床医生识别哪些患者需要加强监测和可能的专科转诊，从而减少晚期鼻-鼻窦癌症的诊断数量。
