PDF(Pubmed)
Abstract：
BACKGROUND: Abnormal results in common blood tests may occur several months before lung cancer (LC) and colorectal cancer (CRC) diagnosis. Identifying early blood markers of cancer and distinct blood test signatures could support earlier diagnosis in general practice.
METHODS: Using linked Australian primary care and hospital cancer registry data, we conducted a cohort study of 855 LC and 399 CRC patients diagnosed between 2001 and 2021. Requests and results from general practice blood tests (six acute phase reactants [APR] and six red blood cell indices [RBCI]) were examined in the 2 years before cancer diagnosis. Poisson regression models were used to estimate monthly incidence rates and examine pre-diagnostic trends in blood test use and abnormal results prior to cancer diagnosis, comparing patterns in LC and CRC patients.
RESULTS: General practice blood test requests increase from 7 months before CRC and 6 months before LC diagnosis. Abnormalities in many APR and RBCI tests increase several months before cancer diagnosis, often occur prior to or in the absence of anaemia (in 51% of CRC and 81% of LC patients with abnormalities), and are different in LC and CRC patients.
CONCLUSIONS: This study demonstrates an increase in diagnostic activity in Australian general practice several months before LC and CRC diagnosis, indicating potential opportunities for earlier diagnosis. It identifies blood test abnormalities and distinct signatures that are early markers of LC and CRC. If combined with other pre-diagnostic information, these blood tests have potential to support GPs in prioritising patients for cancer investigation of different sites to expedite diagnosis.
METHODS: Using linked Australian primary care and hospital cancer registry data, we conducted a cohort study of 855 LC and 399 CRC patients diagnosed between 2001 and 2021. Requests and results from general practice blood tests (six acute phase reactants [APR] and six red blood cell indices [RBCI]) were examined in the 2 years before cancer diagnosis. Poisson regression models were used to estimate monthly incidence rates and examine pre-diagnostic trends in blood test use and abnormal results prior to cancer diagnosis, comparing patterns in LC and CRC patients.
RESULTS: General practice blood test requests increase from 7 months before CRC and 6 months before LC diagnosis. Abnormalities in many APR and RBCI tests increase several months before cancer diagnosis, often occur prior to or in the absence of anaemia (in 51% of CRC and 81% of LC patients with abnormalities), and are different in LC and CRC patients.
CONCLUSIONS: This study demonstrates an increase in diagnostic activity in Australian general practice several months before LC and CRC diagnosis, indicating potential opportunities for earlier diagnosis. It identifies blood test abnormalities and distinct signatures that are early markers of LC and CRC. If combined with other pre-diagnostic information, these blood tests have potential to support GPs in prioritising patients for cancer investigation of different sites to expedite diagnosis.
摘要：
背景：普通血液检查的异常结果可能发生在肺癌（LC）和结直肠癌（CRC）诊断前几个月。识别癌症的早期血液标志物和不同的血液测试特征可以支持一般实践中的早期诊断。
方法：使用关联的澳大利亚初级保健和医院癌症登记数据，我们对2001-2021年间诊断为855例LC和399例CRC患者进行了一项队列研究.在癌症诊断前的2年内，检查了一般实践血液检查的要求和结果（六种急性期反应物[APR]和六种红细胞指数[RBCI]）。使用泊松回归模型来估计每月发病率，并检查癌症诊断前血液检查使用和异常结果的诊断前趋势。比较LC和CRC患者的模式。
结果：从CRC诊断前7个月和LC诊断前6个月，全科医学验血要求增加。许多APR和RBCI测试的异常在癌症诊断前几个月增加，通常发生在贫血之前或没有贫血（51％的CRC和81％的LC异常患者），并且在LC和CRC患者中是不同的。
结论：这项研究表明，在LC和CRC诊断前几个月，澳大利亚全科医生的诊断活动有所增加，提示早期诊断的潜在机会。它可以识别血液测试异常和明显的特征，这是LC和CRC的早期标志物。如果与其他预诊断信息结合使用，这些血液检查有可能支持全科医生优先考虑患者进行不同部位的癌症调查,以加快诊断.
方法：使用关联的澳大利亚初级保健和医院癌症登记数据，我们对2001-2021年间诊断为855例LC和399例CRC患者进行了一项队列研究.在癌症诊断前的2年内，检查了一般实践血液检查的要求和结果（六种急性期反应物[APR]和六种红细胞指数[RBCI]）。使用泊松回归模型来估计每月发病率，并检查癌症诊断前血液检查使用和异常结果的诊断前趋势。比较LC和CRC患者的模式。
结果：从CRC诊断前7个月和LC诊断前6个月，全科医学验血要求增加。许多APR和RBCI测试的异常在癌症诊断前几个月增加，通常发生在贫血之前或没有贫血（51％的CRC和81％的LC异常患者），并且在LC和CRC患者中是不同的。
结论：这项研究表明，在LC和CRC诊断前几个月，澳大利亚全科医生的诊断活动有所增加，提示早期诊断的潜在机会。它可以识别血液测试异常和明显的特征，这是LC和CRC的早期标志物。如果与其他预诊断信息结合使用，这些血液检查有可能支持全科医生优先考虑患者进行不同部位的癌症调查,以加快诊断.
