Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle.
Oxford University, Oxford, United Kingdom.
JAMA Netw Open. 2023 May 1;6(5):e2312042. doi: 10.1001/jamanetworkopen.2023.12042.
Lung cancer, the US's leading cause of cancer death, is often diagnosed following presentation to health care settings with symptoms, and many patients present with late-stage disease.
To investigate the association between weight loss and subsequent diagnosis of incident lung cancer in an ambulatory care population and to assess whether recorded weight change had higher odds of lung cancer diagnosis than objective measurements.
DESIGN, SETTING, AND PARTICIPANTS: This case-control study included patients visiting a US academic medical center between January 1, 2012, and December 31, 2019. Data were derived from US ambulatory care electronic health records from the University of Washington Medical Center linked to the local Surveillance, Epidemiology, and End Results cancer registry. Cases were identified from patients who had a primary lung cancer diagnosis between 2012 and 2019; controls were matched on age, sex, smoking status, and presenting to the same type of ambulatory clinic as cases. Data were analyzed from March 2022 through January 2023.
Continuous and categorical weight change were assessed.
Odds ratios estimating the likelihood of a diagnosis of lung cancer were calculated using univariable and multivariable conditional logistic regression.
A total of 625 patients aged 40 years or older with a first primary lung cancer diagnosis and 4606 matched controls were included (1915 [36.6%] ages 60 to 69 years; 418 [8.0%] Asian, 389 [7.4%] Black, 4092 [78.2%] White). In unadjusted analyses, participants with weight loss of 1% to 3% (odds ratio [OR], 1.12; 95% CI, 0.88-1.41), 3% to 5% (OR, 1.36; 95% CI, 0.99-1.88), or 5% to 10% (OR, 1.23; 95% CI, 0.82-1.85) over a 2-year period did not have statistically significantly increased risk of lung cancer diagnosis compared with those who maintained a steady weight. However, participants with weight loss of 10% to 50% had more than twice the odds of a lung cancer diagnosis (OR, 2.27; 95% CI, 1.27-4.05). Most categories of weight loss showed significant associations with an increased risk of lung cancer diagnosis for at least 6 months prior to diagnosis. Patients who had weight loss both recorded in clinicians' notes and measured had higher odds of lung cancer compared with patients who had only recorded (OR, 1.26; odds; 95% CI, 1.04-1.52) or measured (OR, 8.53; 95% CI, 6.99-10.40) weight loss.
In this case-control study, weight loss in the prior 6 months was associated with incident lung cancer diagnosis and was present whether weight loss was recorded as a symptom by the clinician or based on changes in routinely measured weight, demonstrating a potential opportunity for early diagnosis. The association between measured and recorded weight loss by clinicians presents novel results for the US.
肺癌是美国癌症死亡的主要原因，通常在出现症状后在医疗机构就诊时被诊断出来，而且许多患者就诊时已处于晚期疾病。
研究在门诊人群中体重减轻与随后诊断出的肺癌之间的关联，并评估记录的体重变化与客观测量相比，是否具有更高的肺癌诊断几率。
设计、地点和参与者：本病例对照研究纳入了 2012 年 1 月 1 日至 2019 年 12 月 31 日期间在美国学术医疗中心就诊的患者。数据来自华盛顿大学医学中心的美国门诊电子健康记录，并与当地的监测、流行病学和最终结果癌症登记处进行了链接。病例是根据 2012 年至 2019 年期间的原发性肺癌诊断确定的；对照则根据年龄、性别、吸烟状况和与病例相同的门诊诊所就诊情况进行匹配。数据分析于 2022 年 3 月至 2023 年 1 月进行。
评估了连续和分类的体重变化。
使用单变量和多变量条件逻辑回归计算了估计肺癌诊断可能性的比值比。
共纳入了 625 名年龄在 40 岁或以上的首次原发性肺癌诊断患者和 4606 名匹配的对照者（60 至 69 岁 1915 名[36.6%]；亚洲人 418 名[8.0%]；黑人 389 名[7.4%]；白人 4092 名[78.2%]）。在未经调整的分析中，体重减轻 1%至 3%（比值比[OR]，1.12；95%置信区间[CI]，0.88-1.41）、3%至 5%（OR，1.36；95% CI，0.99-1.88）或 5%至 10%（OR，1.23；95% CI，0.82-1.85）的患者与体重稳定的患者相比，肺癌诊断的风险没有统计学显著增加。然而，体重减轻 10%至 50%的患者患肺癌的几率是前者的两倍多（OR，2.27；95% CI，1.27-4.05）。大多数类别的体重减轻在诊断前至少 6 个月与肺癌诊断风险的增加显著相关。与仅记录（OR，1.26；95% CI，1.04-1.52）或测量（OR，8.53；95% CI，6.99-10.40）体重减轻的患者相比，既在临床医生的记录中记录又经测量的体重减轻患者具有更高的肺癌诊断几率。
在这项病例对照研究中，前 6 个月的体重减轻与肺癌的发生诊断相关，无论体重减轻是由临床医生记录为症状还是基于常规测量的体重变化，都表现出潜在的早期诊断机会。临床医生记录和测量的体重减轻之间的关联为美国提供了新的结果。
