Institute of Child Health, University College London, London, UK.
Lifespan and Population Health, University of Nottingham, Nottingham, UK.
Arch Dis Child. 2024 Jan 22;109(2):113-120. doi: 10.1136/archdischild-2023-325875.
Time to diagnosis (TTD) of childhood soft tissue sarcoma (STS) is significantly associated with survival. This review aims to identify pre-diagnostic symptoms/signs to inform earlier diagnosis interventions.
Medline, Embase, Cochrane and Web-of-Science were searched between January 2010 and February 2021 for studies including children (<18 years) diagnosed with STS, with no language restrictions. Pooled proportions of symptoms/signs were calculated and subanalysed by tumour location and age.
Fifty-nine eligible studies were identified, totalling 2462 cases. The most frequent symptoms were lump/swelling (38%, 95% CI 27% to 51%), pain (6%, 95% CI 3% to 10%), cutaneous changes (4%, 95% CI 0 to 9%), localised eye swelling (3%, 95% CI 0 to 7%), cranial nerve deficits (2%, 95% CI 0 to 5%) and constitutional symptoms (2%, 95% CI 0 to 5%).Symptoms varied by location and age. Localised eye swelling (20%, 95% CI 3% to 45%), cranial nerve deficits (14%, 95% CI 4% to 28%) and impaired visual function (6%, 95% CI 0 to 17%) were frequent in head and neck tumours. For abdomen/pelvic tumours, urinary symptoms (24%, 95% CI 5% to 15%), abdominal distension/discomfort (22%, 95% CI 4% to 47%), genital lump/swelling (16%, 95% CI 1% to 42%), constitutional symptoms (9%, 95% CI 0%] to 23%), vaginal bleeding (7%, 95%C I 0 to 21%) and bowel habit changes (6%, 95% CI 0 to 17%) were frequent.In <5 years, consumptive coagulopathy (16%, 95% CI 0 to 48%), cutaneous changes (5%, 95% CI 0 to 40%), genital lump/swelling (4%, 95% CI 0 to 14%), reduced mobility (3%, 95% CI 0 to 11%), vaginal bleeding (2%, 95% CI 0 to 11%) and bleeding/bruising/petechiae (2%, 95% CI 0 to 20%) were frequent compared with lump/swelling, constitutional symptoms, pain and headaches which were frequent among >11 years.
For STS, pre-diagnostic symptoms differ by age and location, highlighting the need to tailor early diagnosis interventions.
儿童软组织肉瘤（STS）的诊断时间（TTD）与生存显著相关。本综述旨在确定诊断前的症状/体征，以告知更早的诊断干预措施。
在 2010 年 1 月至 2021 年 2 月期间，检索了 Medline、Embase、Cochrane 和 Web-of-Science，纳入了诊断为 STS 的儿童（<18 岁）的研究，无语言限制。计算了症状/体征的合并比例，并按肿瘤位置和年龄进行了亚分析。
确定了 59 项符合条件的研究，共纳入 2462 例病例。最常见的症状是肿块/肿胀（38%，95%CI 27%至 51%）、疼痛（6%，95%CI 3%至 10%）、皮肤改变（4%，95%CI 0 至 9%）、局部眼部肿胀（3%，95%CI 0 至 7%）、颅神经缺陷（2%，95%CI 0 至 5%）和全身症状（2%，95%CI 0 至 5%）。症状因位置和年龄而异。局部眼部肿胀（20%，95%CI 3%至 45%）、颅神经缺陷（14%，95%CI 4%至 28%）和视力受损（6%，95%CI 0 至 17%）在头颈部肿瘤中较为常见。对于腹部/盆腔肿瘤，泌尿系统症状（24%，95%CI 5%至 15%）、腹部膨胀/不适（22%，95%CI 4%至 47%）、生殖器肿块/肿胀（16%，95%CI 1%至 42%）、全身症状（9%，95%CI 0%至 23%）、阴道出血（7%，95%C I 0 至 21%）和肠道习惯改变（6%，95%CI 0 至 17%）较为常见。在<5 岁的患者中，消耗性凝血病（16%，95%CI 0 至 48%）、皮肤改变（5%，95%CI 0 至 40%）、生殖器肿块/肿胀（4%，95%CI 0 至 14%）、活动能力下降（3%，95%CI 0 至 11%）、阴道出血（2%，95%CI 0 至 11%）和出血/瘀伤/瘀点（2%，95%CI 0 至 20%）较常见，而肿块/肿胀、全身症状、疼痛和头痛在>11 岁的患者中更为常见。
对于 STS，诊断前的症状因年龄和位置而异，这突出表明需要针对早期诊断干预措施进行调整。
