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Multicenter Study
. 2011 Nov;61(592):e707-14.
doi: 10.3399/bjgp11X606609.

Identifying patients with suspected gastro-oesophageal cancer in primary care: derivation and validation of an algorithm

Julia Hippisley-Cox  1 , Carol Coupland
Affiliations
Multicenter Study

Identifying patients with suspected gastro-oesophageal cancer in primary care: derivation and validation of an algorithm

Julia Hippisley-Cox et al. Br J Gen Pract. 2011 Nov.

Abstract

Background: Gastro-oesphageal is one of the most common cancers worldwide. Evidence suggested that increased awareness of symptoms and earlier diagnosis could help improve treatment options and improve survival.

Aim: To derive and validate an algorithm to estimate the absolute risk of having gastro-oesophageal cancer in patients in primary care with and without symptoms.

Design and setting: Cohort study of 375 UK QResearch® general practices for development, and 189 for validation.

Method: Included patients were aged 30-84 years, free at baseline of a diagnosis of gastro-oesophageal cancer, and without dysphagia, haematemesis, abdominal pain, appetite loss, or weight loss recorded in previous 12 months. The primary outcome was incident diagnosis of gastro-oesophageal cancer recorded in the next 2 years. Risk factors examined were age, body mass index, alcohol status, smoking status, deprivation, family history of gastrointestinal cancer, dysphagia, previous diagnosis of cancer apart from gastro-oesophageal cancer, haematemesis, abdominal pain, appetite loss, weight loss, tiredness, and anaemia. Cox proportional hazards models were used to develop risk equations. Measures of calibration and discrimination assessed performance in the validation cohort.

Results: There were 2527 incident cases of gastro-oesophageal cancer from 4.1 million person-years in the derivation cohort. Independent predictors were age, smoking, dysphagia, haematemesis, abdominal pain, appetite loss, weight loss, and anaemia. On validation, the algorithms explained 71% of the variation in females and 73% in males. The receiver operating curve statistics were 0.89 (females) and 0.92 (males). The D statistic was 3.2 (females) and 3.3 (males). The 10% of patients with the highest predicted risks included 77% of all gastro-oesophageal cancers diagnosed over the next 2 years.

Conclusion: The algorithm has good performance and could potentially be used to help identify those at highest risk of gastro-oesophageal cancer, to facilitate early referral and investigation.

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Figures

Figure 1
Figure 1
Incidence rates of dysphagia, haematemesis, appetite loss, weight loss, and abdominal pain in males and females per 100 000 person-years in the derivation cohort.
Figure 2
Figure 2
Hazard ratios for gastro-oesophageal cancer by age.
Figure 3
Figure 3
Hazard ratios for symptoms for gastro-oesophageal cancer by age in females.
Figure 4
Figure 4
Hazard ratios for symptoms for gastro-oesophageal cancer by age in males.
Figure 5
Figure 5
Mean predicted risk and observed risk of gastro-oesophageal cancer over 2 years by tenth of predicted risk applying the risk-prediction scores to the validation cohort.
See this image and copyright information in PMC

Comment in

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