Background
“Does this patient have cancer?” is a question frequently asked when confronted by
patients with involuntary weight loss. The aim of this study was to assess the value
of age, erythrocyte sedimentation rate (ESR), and anemia in the diagnosis of cancer
as a cause of involuntary weight loss.
Methods
A retrospective study of 7850 patients admitted to the Department of Internal Medicine
from January to September 2003 was performed. Especially selected were 431 patients
with weight loss. Age, ESR, hemoglobin, and the discharge diagnosis were recorded.
Results
Twenty-four percent of the patients with involuntary weight loss had cancer. Age,
ESR, and anemia were found not to be of value in the diagnosis of cancer (areas under
the curve were 0.684, 0.690, and 0.766, respectively). When diagnostic tests for age,
a high ESR, and anemia were used serially, the positive predictive value for a malignancy
was 64% (CI: 27–90%); when the tests were utilized in parallel, the negative predictive
value was 91% (CI: 85–100%).
Conclusions
Any patient admitted to our Department of Internal Medicine for involuntary weight
loss had a 24% probability of having a malignancy. Neither age, nor ESR, nor anemia,
used separately as a multilevel, diagnostic test or combined serially or in parallel,
could exclude or rule in the diagnosis of cancer. However, they could increase (from
24% to 64%) or decrease (from 24% to 9%) the probability of cancer.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Discriminating ability of the erythrocyte sedimentation rate: a prospective study in general practice.Br J Gen Pract. 1991; 41: 365-370
- Serum markers and clinical data in diagnosing pancreatic cancer: a contrastive approach.Am J Gastroenterol. 1988; 83: 549-553
- Prognosis of patients with advanced Hodgkin's disease: evaluation of four prognostic models using 344 patients included in the Group d'Etudes des Lymphomes de l'Adulte Study.Cancer. 1997; 80: 1124-1133
- Clinical significance of extreme elevation of the erythrocyte sedimentation rate.Arch Intern Med. 1986; 146: 1581-1583
- The significance of erythrocyte sedimentation rate as a prognostic factor for patients with prostate cancer: Gunma Urological Oncology Study Group investigation.Jpn J Cancer Res. 1990; 81: 971-974
- Prospective survey of investigations in outpatients referred with iron deficiency anaemia.Gut. 1993; 34: 1102-1107
- Valeur d'un score utilisant les variables cliniques et biologiques pour determiner la benignite ou la malignite d'une masse hepatique.Gastroenterol Clin Biol. 1989; 13: 340-342
- Multivariate analysis of six serum tumor markers (CEA, CA 50, CA 242, TPA, TPS, TATI) and conventional laboratory tests in the diagnosis of hepatopancreatobiliary malignancy.Anticancer Res. 1995; 15: 2731-2737
- Serum CA15.3, CEA and ESR patterns in breast cancer.Int J Biol Markers. 1997; 12: 168-173
- Clinical utility of the erythrocyte sedimentation rate in preoperative evaluation of solitary skeletal lesions.J Orthop Res. 1984; 2: 262-268
- On the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain in general practice. A criteria-based review of the literature.Spine. 1995; 20: 318-327
- Finding cancer in primary care outpatients with low back pain: a comparison of diagnostic strategies.J Gen Intern Med. 2001; 16: 14-23
- Screening of malignant pleural effusion by discriminant analysis.Int J Tuberc Lung Dis. 2003; 7: 892-898
- Age and alarm symptoms do not predict endoscopic findings among patients with dyspepsia: a multicentre database study.Gut. 2001; 49: 29-34
- Involuntary weight loss: diagnostic and prognostic significance.Ann Intern Med. 1981; 95: 568-574
- Clinical evaluation for cancer in patients with involuntary weight loss without specific symptoms.Am J Med. 2003; 114: 631-637
- Involuntary weight loss without specific symptoms: a clinical prediction score for malignant neoplasm.QJM. 2003; 96: 649-655
- Gain and loss in weight.in: Harrison's principles of internal medicine. 14th edition. McGraw-Hill, 1998: 244-245
- Clinical epidemiology. A basic science for clinical medicine. 2nd edition. Little, Brown, 1991: 118
- Multivariable analysis. A practical guide for clinicians. Cambridge University Press, Cambridge1999: 158-163
- Clinical epidemiology and biostatistics. Williams and Wilkins, Baltimore1992: 43-44
- Unintentional weight loss: diagnosis and prognosis. The first prospective follow-up study from a secondary referral centre.J Intern Med. Jan 2001; 249: 41-46
Article info
Publication history
Accepted:
July 28,
2005
Received in revised form:
July 8,
2005
Received:
February 4,
2005
Identification
Copyright
© 2005 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
