Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK.
UCL Cancer Institute, University College London, London, UK.
BMC Cancer. 2024 Jun 11;24(1):718. doi: 10.1186/s12885-024-12372-w.
The diagnosis of B-cell lymphoma, one of the commonest cancers seen in childhood and adolescence, is challenging. There is a crucial need to identify and delineate the prevalence of associated symptoms in order to improve early diagnosis.
To identify clinical presentations associated with childhood and adolescent B-cell lymphomas and estimate symptom prevalence.
A systematic review of observational studies and meta-analysis of proportions was carried out. Medline and EMBASE were systematically searched, with no language restrictions, from inception to 1st August 2022. Observational studies with at least 10 participants, exploring clinical presentations of any childhood and adolescent lymphoma, were selected. Proportions from each study were inputted to determine the weighted average (pooled) proportion, through random-effects meta-analysis.
Studies reported on symptoms, signs and presentation sites at diagnosis of 12,207 children and adolescents up to the age of 20. Hodgkin's lymphoma most frequently presented with adenopathy in the head-and-neck region (79% [95% CI 58%-91%]), whilst non-Hodgkin's lymphoma presented abdominally (55% [95% CI 43%-68%]). Symptoms associated with lymphoma included cervical lymphadenopathy (48% [95% CI 20%-77%]), peripheral lymphadenopathy (51% [95% CI 37%-66%]), B-symptoms (40% [95% CI 34%-44%]), fever (43% [95% CI 34%-54%]), abdominal mass (46% [95% CI 29%-64%]), weight loss (53% [95% CI 39%-66%]), head-and-neck mass (21% [95% CI 6%-47%]), organomegaly (29% [95% CI 23%-37%]), night sweats (19% [95% CI 10%-32%]), abdominal pain (28% [95% CI 15%-47%]), bone pain (17% [95% CI 10%-28%]) and abnormal neurology (11% [95% CI 3%-28%]).
This systematic review and meta-analysis of proportions provides insight into the heterogeneous clinical presentations of B-cell lymphoma in childhood and adolescence and provides estimates of symptom prevalence. This information is likely to increase public and clinical awareness of lymphoma presentations and aid earlier diagnosis. This review further highlights the lack of studies exploring childhood and adolescent lymphoma presentations in primary care, where patients are likely to present at the earliest stages of their disease.
B 细胞淋巴瘤是儿童和青少年中最常见的癌症之一，其诊断具有挑战性。为了提高早期诊断的水平，迫切需要识别和描述相关症状的流行情况。
确定与儿童和青少年 B 细胞淋巴瘤相关的临床表现，并估计症状的流行率。
对观察性研究进行系统回顾和比例的荟萃分析。从 1947 年 1 月至 2022 年 8 月 1 日，系统地检索了 Medline 和 EMBASE，不限制语言。选择了至少有 10 名参与者的研究，以探讨任何儿童和青少年淋巴瘤的临床表现。从每项研究中输入比例，通过随机效应荟萃分析确定加权平均值（合并）。
本研究共纳入 12207 名年龄在 20 岁以下的儿童和青少年的症状、体征和诊断部位。霍奇金淋巴瘤最常表现为头颈部淋巴结肿大（79% [95%CI 58%-91%]），而非霍奇金淋巴瘤则表现为腹部（55% [95%CI 43%-68%]）。与淋巴瘤相关的症状包括颈淋巴结病（48% [95%CI 20%-77%]）、外周淋巴结病（51% [95%CI 37%-66%]）、B 症状（40% [95%CI 34%-44%]）、发热（43% [95%CI 34%-54%]）、腹部肿块（46% [95%CI 29%-64%]）、体重减轻（53% [95%CI 39%-66%]）、头颈部肿块（21% [95%CI 6%-47%]）、器官肿大（29% [95%CI 23%-37%]）、盗汗（19% [95%CI 10%-32%]）、腹痛（28% [95%CI 15%-47%]）、骨痛（17% [95%CI 10%-28%]）和异常神经学表现（11% [95%CI 3%-28%]）。
本系统回顾和比例荟萃分析提供了儿童和青少年 B 细胞淋巴瘤异质性临床表现的见解，并提供了症状流行率的估计。这些信息可能会提高公众和临床医生对淋巴瘤表现的认识，有助于早期诊断。本研究进一步强调了缺乏研究探索儿童和青少年淋巴瘤在初级保健中的表现，而患者很可能在疾病的早期阶段就诊。
