Thrombocytosis is a risk marker for lung cancer in primary care. We investigated whether thrombocytosis presents pre-diagnostically for all the histological subtypes of lung cancer and its association with the stage at diagnosis. A matched cohort study used English electronic primary care data linked to the national cancer registry. Patients diagnosed with lung cancer aged ≥40 years with no prior history of malignancy were matched by age, sex, and general practice to five controls without lung cancer. Multivariable logistic regression models quantified the incidence of pre-diagnostic thrombocytosis and advanced-stage diagnoses, adjusting for COPD diagnosis, smoking status, and anti-platelet drug prescriptions. A total of 9504 cases were matched to 45,647 controls, consisting of 3260 (34%) adenocarcinomas (ADC), 2020 (21%) squamous cell carcinomas (SCC), 70 (<1%) large-cell carcinomas (LCC), and 1089 (12%) small-cell lung cancers (SCLC). The patients with lung cancer were 8.9 (95% CI 8.0–9.9) times more likely to exhibit pre-diagnostic thrombocytosis than the controls. The odds ratios were highest for the comparison between SCC and ADC (1.8, 95% CI 1.5–2.1). Thrombocytosis is associated with advanced-stage ADC and SCC but presented equally for early- and advanced-stage SCLC. Pre-diagnostic thrombocytosis may aid in the detection of all the histological subtypes in primary care.
血小板增多症是初级保健中肺癌的风险标志物。本研究旨在探讨血小板增多是否在所有组织学亚型的肺癌诊断前出现，及其与诊断分期的关联性。本研究采用匹配队列设计，将英国电子初级保健数据与国家癌症登记系统关联。纳入年龄≥40岁、无恶性肿瘤病史的肺癌确诊患者，按年龄、性别和全科诊所与五名非肺癌对照者进行匹配。通过多变量逻辑回归模型量化诊断前血小板增多症的发生率及晚期诊断情况，并调整慢性阻塞性肺疾病诊断、吸烟状态和抗血小板药物处方等混杂因素。最终匹配9504例病例与45647例对照，包括3260例（34%）腺癌、2020例（21%）鳞状细胞癌、70例（<1%）大细胞癌和1089例（12%）小细胞肺癌。肺癌患者出现诊断前血小板增多症的概率是对照组的8.9倍（95% CI 8.0–9.9）。鳞状细胞癌与腺癌的比值比差异最为显著（1.8，95% CI 1.5–2.1）。血小板增多症与晚期腺癌和鳞状细胞癌相关，但在小细胞肺癌的早期与晚期阶段表现无差异。诊断前血小板增多症可能有助于初级保健中发现所有组织学亚型的肺癌。
The Clinical Value of Pre-Diagnostic Thrombocytosis for the Detection of Lung Cancer in Primary Care
肿瘤(癌症)患者之家