Background
Methods
Setting and patients
Study design
Laboratory procedures
Statistical analysis
Results
Patients: inclusion, work-up and follow-up
Characteristic | Patients without cancer | Patients with gastrointestinal cancer | Patients with other cancers |
---|---|---|---|
Age (yr) | 67 (22, 94) | 70 (55, 82) | 66 (44, 93) |
Male sex | 104 (48%) | 12 (54%) | 30 (58%) |
RDW (%) | 14.5 (10.3, 26.7) | 14.8 (12.3, 20.4) | 15.1 (11.5, 20.8) |
Haemoglobin (g/dL) | 12.6 (6.14, 17.4) | 11.3 (7.9, 15.1) | 11.8 (5.42, 17.7) |
MCV (fL) | 88 (62, 124) | 84.5 (64, 98) | 88.2 (72, 102) |
Serum iron (mcg/dL) | 54 (10, 197) | 35.5 (10, 118) | 35 (4, 162) |
Ferritin (mcg/L) | 99.5 (3, 2000) | 26.5 (10, 500) | 226 (15, 1105) |
ESR (mm/h) | 28 (2, 140) | 44.5 (3, 140) | 58 (11, 140) |
CRP (mg/L) | 5 (0.51, 328) | 22 (1.6, 125) | 46 (1, 550) |
ALAT (u/L) | 18 (6, 325) | 18 (10, 71) | 26 (10, 143) |
Total number | 216 | 22 | 52 |
Outcome
Gastrointestinal cancer | Colorectal cancer | |
---|---|---|
AUC (95% CI) | AUC (95% CI) | |
Ferritin | 0.746 (0.691-0.794) | 0.765 (0.713-0.813) |
MCV | 0.627 (0.568-0.684) | 0.669 (0.612-0.725) |
Serum iron | 0.636 (0.571-0.697) | 0.650 (0.584-0.710) |
Haemoglobin | 0.590 (0.530-0.646) | 0.552 (0.491-0.609) |
RDW | 0.541 (0.476-0.602) | 0.463 (0.401-0.528) |
Gastrointestinal cancer | Colorectal cancer | ||
---|---|---|---|
Ferritin (cut-off 100 mcg/L) | Sensitivity (%) | 86 (67–95) | 93 (69–100) |
Specificity (%) | 57 (51–62) | 56 (50–62) | |
Positive predictive value (%) | 14 (9–21) | 10 (6–16) | |
Negative predictive value (%) | 98 (94–100) | 99 (96–100) | |
Positive likelihood ratio | 2 | 2.1 | |
Negative likelihood ratio | 0.24 | 0.13 | |
Sensitivity (%) | 59 (39–77) | 64 (39–84) | |
Specificity (%) | 76 (71–81) | 75 (70–80) | |
Ferritin (cut-off 50 mcg/L) | Positive predictive value (%) | 17 (10–27) | 12(6–20) |
Negative predictive value (%) | 96 (92–98) | 98 (95–99) | |
Positive likelihood ratio | 2.5 | 2.6 | |
Negative likelihood ratio | 0.54 | 0.47 | |
Sensitivity (%) | 68 (47–84) | 64 (39–84) | |
Specificity (%) | 51 (45–57) | 50 (44–56) | |
Anaemia | Positive predictive value (%) | 10 (6–16) | 6 (3–11) |
Negative predictive value (%) | 95 (90–98) | 97 (92–99) | |
Positive likelihood ratio | 1.4 | 1.3 | |
Negative likelihood ratio | 0.63 | 0.71 |
Variable | Odds ratio | 95% CI |
Pvalue | |
---|---|---|---|---|
Colorectal | sex (male) | 1.18 | 0.26, 5.36 | 0.824 |
cancer | age (years) | 1.08 | 0.99, 1.17 | 0.053 |
(14 patients) | hemoglobin (g/dl) | 0.84 | 0.53, 1.34 | 0.473 |
MCV (femtoliters)
| 0.87 | 0.76, 0.99 |
0.049
| |
serum iron (mcg/dl) | 0.99 | 0.96, 1.02 | 0.601 | |
RDW (%) | 0.70 | 0.43, 1.13 | 0.148 | |
ferritin < 100 mcg/L
|
11.57
|
1.34, 99.21
|
0.026
| |
Gastrointestinal | sex (male) | 1.54 | 0.51, 4.68 | 0.443 |
cancer | age (years) | 1.05 | 0.99, 1.10 | 0.060 |
(22 patients) | hemoglobin (g/dl) | 0.86 | 0.64, 1.51 | 0.310 |
MCV (femtoliters) | 0.97 | 0.89, 0.05 | 0.441 | |
serum iron (mcg/dl) | 0.99 | 0.97, 1.01 | 0.392 | |
RDW (%) | 0.98 | 0.74, 1.31 | 0.906 | |
ferritin < 100 mcg/L
|
6.96
|
1.84, 26.27
|
0.004
|
Gastrointestinal cancer | Colorectal cancer | ||||
---|---|---|---|---|---|
AUC (95%CI) | AUC (95%CI) | ||||
Anemia, present (145 patients, 15/9 with gastrointestinal/ colorectal cancer) | Ferritin |
P < 0.001
*
|
P < 0.001
*
| ||
(100mcg/L) | |||||
Ferritin |
P < 0.001
*
|
P = 0.005
*
| |||
Ferritin (mcg/L) |
P = 0.001
†
|
0.799
|
P < 0.001
†
|
0.839
| |
(50 mcg/L) | |||||
(0.713-0.813)
|
(0.765-0.913)
| ||||
Anemia, absent (142 patients, 7/5 with gastrointestinal/ colorectal cancer) | Ferritin (100mcg/L) | P = 0.125
*
| P = 0.375
*
| ||
Ferritin | P = 0.196
*
| P = 0.154
*
| |||
(50 mcg/L) | |||||
Ferritin (mcg/L) | P = 0.536 †
| 0.663 | P = 1.000†
| 0.635 | |
(0.468-0.859) | (0.391-0.880) |
Discussion
Localisation of cancer | nr | Ferritin | Anaemia | ESR | PCR | ALAT | Alcoholism |
---|---|---|---|---|---|---|---|
CAECUM | 1 | 38 |
NO
| 16 | 5.7 | 12.7 | NO |
COLON | 1 | 71 | YES |
101
|
77.4
| 13 | NO |
(ascending, | 2 | 82 | YES |
140
|
125
| 30 | NO |
transverse, | 3 | 26 | YES |
57
|
25.6
| 21.7 | NO |
descending) | 4 | 10 | YES |
60
| 1.7 | 12 | NO |
5 | 20 | YES |
71
|
53
| 12 | NO | |
6 | 14 | YES |
44
|
29.6
| 14.6 | NO | |
7 | 17 | YES |
45
|
22
|
34
|
YES
| |
STOMACH | 1 | 16 |
NO
| 10 | 1.59 | 15 | NO |
2 | 87 | YES |
53
|
110
|
47
|
YES
| |
3 | 12 | YES |
44
|
40
| 24 | NO | |
4 |
108
| YES | 29 |
26.5
|
71
|
YES
| |
5 | 15 | YES | 24 |
18.7
| 24 | NO | |
6 |
500
| YES |
90
|
51
| 30 | NO | |
7 | 86 |
NO
| 36 |
21.7
| 18 | NO | |
8 | 11 | YES | 40 |
20.7
| 10 | NO | |
ILEUM | 1 | 58 | YES |
49
|
35
| NO | |
RECTUM | 1 | 27 |
NO
|
51
|
36.5
| 13 | NO |
2 |
322
|
NO
|
56
|
27
| 31 | NO | |
3 | 18 |
NO
| 3 | 7.3 | 19 | NO | |
SIGMOID | 1 | 23 | YES | 16 | 16 | 10 | NO |
2 | 83 |
NO
| 18 | 3 | 10.4 | NO |