{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:00:58Z","timestamp":1789707658763,"version":"4.0.1"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T00:00:00Z","timestamp":1612828800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T00:00:00Z","timestamp":1612828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Br J Cancer"],"published-print":{"date-parts":[[2021,4,27]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Combinations of inflammatory markers are used as prognostic scores in cancer patients with cachexia. We investigated whether they could also be used to prioritise patients attending primary care with unexpected weight loss for cancer investigation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We used English primary care electronic health records data linked to cancer registry data from 12,024 patients with coded unexpected weight loss. For each individual inflammatory marker and score we estimated the sensitivity, specificity, likelihood ratios, positive predictive value (PPV) and the area under the curve along with 95% confidence intervals for a cancer diagnosis within six months.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The risk of cancer associated with two abnormal inflammatory markers combined in a score was higher than the risk associated with individual inflammatory marker abnormalities. However, the risk of cancer in weight loss associated with individual abnormalities, notably a raised C-reactive protein, was sufficient to trigger further investigation for cancer under current NICE guidelines.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>If scores including pairs of inflammatory marker abnormalities were to be used, in preference to individual abnormalities, fewer people would be investigated to diagnose one cancer with fewer false positives, but fewer people with cancer would be diagnosed overall.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1038\/s41416-021-01282-4","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T07:20:03Z","timestamp":1612855203000},"page":"1540-1542","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Individual inflammatory marker abnormalities or inflammatory marker scores to identify primary care patients with unexpected weight loss for cancer investigation?"],"prefix":"10.1038","volume":"124","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0661-7362","authenticated-orcid":false,"given":"B. D.","family":"Nicholson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. L.","family":"Oke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Aveyard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. T.","family":"Hamilton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. D. R.","family":"Hobbs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,9]]},"reference":[{"key":"1282_CR1","doi-asserted-by":"publisher","first-page":"l5774","DOI":"10.1136\/bmj.l5774","volume":"367","author":"J Watson","year":"2019","unstructured":"Watson, J., Mounce, L., Bailey, S. E., Cooper, S. L. & Hamilton, W. Blood markers for cancer. BMJ 367, l5774 (2019).","journal-title":"BMJ"},{"key":"1282_CR2","doi-asserted-by":"publisher","first-page":"e586","DOI":"10.3399\/bjgp18X698357","volume":"68","author":"C Koshiaris","year":"2018","unstructured":"Koshiaris, C. et al. Early detection of multiple myeloma in primary care using blood tests: a case-control study in primary care. Br. J. Gen. Pract. 68, e586\u2013e593 (2018).","journal-title":"Br. J. Gen. Pract."},{"key":"1282_CR3","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-017-3845-9","volume":"17","author":"E N\u00e6ser","year":"2017","unstructured":"N\u00e6ser, E., M\u00f8ller, H., Fredberg, U., Frystyk, J. & Vedsted, P. Routine blood tests and probability of cancer in patients referred with non-specific serious symptoms: a cohort study. BMC Cancer 17, 817 (2017).","journal-title":"BMC Cancer"},{"key":"1282_CR4","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1038\/s41416-018-0095-9","volume":"119","author":"RD Dolan","year":"2018","unstructured":"Dolan, R. D. et al. The prognostic value of systemic inflammation in patients undergoing surgery for colon cancer: comparison of composite ratios and cumulative scores. Br. J. Cancer 119, 40\u201351 (2018).","journal-title":"Br. J. Cancer"},{"key":"1282_CR5","doi-asserted-by":"publisher","first-page":"17105","DOI":"10.1038\/nrdp.2017.105","volume":"4","author":"VE Baracos","year":"2018","unstructured":"Baracos, V. E., Martin, L., Korc, M., Guttridge, D. C. & Fearon, K. C. H. Cancer-associated cachexia. Nat. Rev. Dis. Prim. 4, 17105 (2018).","journal-title":"Nat. Rev. Dis. Prim."},{"key":"1282_CR6","doi-asserted-by":"publisher","first-page":"m2651","DOI":"10.1136\/bmj.m2651","volume":"370","author":"BD Nicholson","year":"2020","unstructured":"Nicholson, B. D. et al. Prioritising primary care patients with unexpected weight loss for cancer investigation: diagnostic accuracy study. BMJ 370, m2651 (2020).","journal-title":"BMJ"},{"key":"1282_CR7","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1093\/ije\/dyv098","volume":"44","author":"E Herrett","year":"2015","unstructured":"Herrett, E. et al. Data resource profile: Clinical Practice Research Datalink (CPRD). Int. J. Epidemiol. 44, 827\u2013836 (2015).","journal-title":"Int. J. Epidemiol."},{"key":"1282_CR8","doi-asserted-by":"publisher","first-page":"1848","DOI":"10.1038\/s41416-020-0829-3","volume":"122","author":"BD Nicholson","year":"2020","unstructured":"Nicholson, B. D. et al. The association between unexpected weight loss and cancer diagnosis in primary care: a matched cohort analysis of 65,000 presentations. Br. J. Cancer 122, 1848\u20131856 (2020).","journal-title":"Br. J. Cancer"},{"key":"1282_CR9","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1001\/jama.1994.03510330081039","volume":"271","author":"R Jaeschke","year":"1994","unstructured":"Jaeschke, R., Guyatt, G. H. & Sackett, D. L. Users\u2019 guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA 271, 703\u2013707 (1994).","journal-title":"JAMA"},{"key":"1282_CR10","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1038\/s41416-019-0458-x","volume":"120","author":"J Watson","year":"2019","unstructured":"Watson, J., Salisbury, C., Banks, J., Whiting, P. & Hamilton, W. Predictive value of inflammatory markers for cancer diagnosis in primary care: a prospective cohort study using electronic health records. Br. J. Cancer 120, 1045\u20131051 (2019).","journal-title":"Br. J. Cancer"}],"container-title":["British Journal of Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41416-021-01282-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41416-021-01282-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41416-021-01282-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T11:05:58Z","timestamp":1684753558000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41416-021-01282-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,9]]},"references-count":10,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,4,27]]}},"alternative-id":["1282"],"URL":"https:\/\/doi.org\/10.1038\/s41416-021-01282-4","relation":{},"ISSN":["0007-0920","1532-1827"],"issn-type":[{"value":"0007-0920","type":"print"},{"value":"1532-1827","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,9]]},"assertion":[{"value":"12 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 December 2020","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 January 2021","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 February 2021","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Independent Scientific Application Committee for MHRA database research (ISAC) protocol number 16_164A2A. The study was performed in accordance with the Declaration of Helsinki. Consent to publish Not applicable.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"This study is based on CPRD data and is subject to a full licence agreement, which does not permit data sharing outside of the research team.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"B.D.N. is supported by National Institute for Health Research (NIHR) Doctoral Research Fellowship number (DRF-2015-08-18). P.A. is an NIHR senior investigator and is funded by NIHR Oxford Biomedical Research Centre and the NIHR Applied Research Collaboration (ARC) for Oxford and Thames Valley. W.H. is co-Principal Investigator of the multi-institutional CanTest Research Collaborative funded by a Cancer Research UK Population Research Catalyst award (C8640\/A23385). F.D.R.H. acknowledges his part-funding from the National Institute for Health Research (NIHR) School for Primary Care Research, the NIHR ARC for Oxford and Thames Valley, the NIHR Oxford Biomedical Research Centre (BRC, UHT) and the NIHR Oxford Medtech and InVitro Diagnostics Co-operative (MIC). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding information"}}]}}