Martinez-Gutierrez Javiera, De Mendonca Lucas, Ly Philip, Lee Alex, Hunter Barbara, Manski-Nankervis Jo-Anne, Chima Sophie, Daly Deborah, Fishman George, Lim Fong Seng, Wang Benny, Nelson Craig, Nicholson Brian, Emery Jon
Department of General Practice and Primary Care, The University of Melbourne, Melbourne, Australia
Centre for Cancer Research, University of Melbourne, Melbourne, Australia.
BJGP Open. 2025 Jan 2;8(4). doi: 10.3399/BJGPO.2024.0025. Print 2024 Dec.
Cancer diagnoses often begin with consultations with GPs, but the non-specific nature of symptoms can lead to delayed diagnosis. Unexpected weight loss (UWL) is a common non-specific symptom linked to undiagnosed cancer, yet guidelines for its diagnostic assessment in general practice lack consistency.
To synthesise evidence on the association between UWL and cancer diagnosis, and to review clinical guidelines and recommendations for assessing patients with UWL.
DESIGN & SETTING: Systematic search and analysis of studies conducted in primary care.
Four databases were searched for peer-reviewed literature from 2012 to 2023. Two reviewers conducted all the steps. A narrative review was conducted detailing the evidence for UWL as a risk factor for undiagnosed cancer, existing clinical guidance, and recommended diagnostic approach.
We included 25 studies involving 916 092 patients; 92% provided strong evidence of an association between UWL and undiagnosed cancer. The National Institute for Health Care and Excellence (NICE) Cancer Guideline in the UK was frequently cited. General suggestions encompassed regular weight monitoring, family history, risk factor evaluation, additional signs and symptoms, and a comprehensive physical examination. Commonly recommended pathology tests included C-reactive protein (CRP), complete blood count, alkaline phosphatase, and thyroid-stimulating hormone. Immunochemical faecal occult blood test, abdominal ultrasound, and chest X-ray were also prevalent. One large cohort study provided age, sex, and differential diagnosis-specific recommendations.
This evidence review informs recommendations for investigating patients with UWL and will contribute to a computer decision support tool implementation in primary care, enhance UWL assessment, and potentially facilitate earlier cancer diagnosis.
癌症诊断通常始于与全科医生的会诊，但症状的非特异性可能导致诊断延迟。意外体重减轻（UWL）是一种与未确诊癌症相关的常见非特异性症状，然而，其在全科医疗中的诊断评估指南缺乏一致性。
综合关于UWL与癌症诊断之间关联的证据，并审查评估UWL患者的临床指南和建议。
对初级保健中开展的研究进行系统检索和分析。
检索了四个数据库，以获取2012年至2023年的同行评审文献。由两名评审员完成所有步骤。进行了一项叙述性综述，详细阐述了UWL作为未确诊癌症风险因素的证据、现有的临床指南以及推荐的诊断方法。
我们纳入了25项研究，涉及916092名患者；92%的研究提供了UWL与未确诊癌症之间存在关联的有力证据。英国国家卫生与临床优化研究所（NICE）癌症指南被频繁引用。一般建议包括定期体重监测、家族史、风险因素评估、其他体征和症状以及全面的体格检查。常用的推荐病理检查包括C反应蛋白（CRP）、全血细胞计数、碱性磷酸酶和促甲状腺激素。免疫化学粪便潜血试验、腹部超声和胸部X光检查也很普遍。一项大型队列研究提供了年龄、性别以及特定鉴别诊断的建议。
这项证据综述为调查UWL患者的建议提供了信息，并将有助于在初级保健中实施计算机决策支持工具，加强UWL评估，并有可能促进癌症的早期诊断。
