发表在1月份的British Journal of General Practice杂志上的一项研究"Identifying patients with suspected colorectal cancer in primary care: derivation and validation of an algorithm"表明，诺丁汉大学和ClinRisk公司的研究人员已经研发成功两种新的QCancer算法，这两种算法能综合参考病人的症状及危险因素为最易发展为胰腺癌和肠癌的个体提供预警，从而能帮助医生更快的做出诊断，这将可能在每年内挽救上千人的生命。
这项研究的负责人，诺丁汉大学基层医疗部的Julia Hippisley-Cox教授指出：“我们希望这些新工具能帮助那些难以早期鉴别疑似癌症病人的家庭医生，进而有助于使病人有更好的治疗选择并改善疾病结局。”
胰腺癌在英国每年发病超过8000例。在所有癌症中，胰腺癌的生存率最低，几乎3/4的病人在诊断后一年内死亡。胰腺癌的早期发现显著提高病人的生存，但由于危险因素不明且缺少可靠的筛查工具，胰腺癌也是家庭医生最难发现的癌症之一。
研究者利用564名家庭医生处病人的数据进行算法的研发，并根据体重减轻，食欲不振，腹痛等临床症状以及年龄、慢性胰腺炎、吸烟和糖尿病等危险因素进行综合考虑，对此算法进行验证，成功预测了那些病人易患胰腺癌。
在随访两年期间，此算法成功了预测了62%的胰腺癌，这些病例均来自于病人中10%的预测发病风险最高的那一部分。结直肠癌也称为肠癌，在欧洲是第二最常见的癌症，也是癌症相关死亡的第二常见原因。
在英国，每年肠癌的发病和死亡人数分别为36,000和16,500。英国肠癌的生存率在欧洲最低，一般认为主要是由于症状出现较晚、诊断和治疗的延迟。快速的早期诊断可以使情况大为改善，早期诊断的患者五年生存率能高达90%。肠癌的一些主要症状如直肠出血，体重减轻，食欲不振，腹泻，便秘，腹痛非常常见，这症状也常见于其他不太严重的一些疾病，也为家庭医生的诊断增加了困难。（生物谷Bioon.com）
doi:10.3399/bjgp12X616346
PMC:
PMID:
Identifying patients with suspected colorectal cancer in primary care: derivation and validation of an algorithm
Hippisley-Cox, Julia; Coupland, Carol
Background
Earlier diagnosis of colorectal cancer could help improve survival so better tools are needed to help this.
Aim
To derive and validate an algorithm to quantify the absolute risk of colorectal cancer in patients in primary care with and without symptoms.
Design and setting
Cohort study using data from 375 UK QResearch® general practices for development and 189 for validation.
Method
Included patients were aged 30-84 years, free at baseline from a diagnosis of colorectal cancer and without rectal bleeding, abdominal pain, appetite loss, or weight loss in the previous 12 months. The primary outcome was incident diagnosis of colorectal cancer recorded in the next 2 years. Risk factors examined were age, body mass index, smoking status, alcohol status, deprivation, diabetes, inflammatory bowel disease, family history of gastrointestinal cancer, gastrointestinal polyp, history of another cancer, rectal bleeding, abdominal pain, abdominal distension, appetite loss, weight loss, diarrhoea, constipation, change of bowel habit, tiredness, and anaemia. Cox proportional hazards models were used to develop separate risk equations in males and females. Measures of calibration and discrimination assessed performance in the validation cohort.
Results
There were 4798 incident cases of colorectal cancer from 4.1 million person-years in the derivation cohort. Independent predictors in males and females included family history of gastrointestinal cancer, anaemia, rectal bleeding, abdominal pain, appetite loss, and weight loss. Alcohol consumption and recent change in bowel habit were also predictors in males. On validation, the algorithms explained 65% of the variation in females and 67% in males. The receiver operating curve statistics were 0.89 (females) and 0.91 (males). The D statistic was 2.8 (females) and 2.9 (males). The 10% of patients with the highest predicted risks contained 71% of all colorectal cancers diagnosed over the next 2 years
Conclusion
The algorithm has good discrimination and calibration and could potentially be used to help identify those at highest risk of current colorectal cancer, to facilitate early referral and investigation.
