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Open Access Research article

Ferritin above 100 mcg/L could rule out colon cancer, but not gastric or rectal cancer in patients with involuntary weight loss

Cristian Baicus135*, Simona Caraiola135, Mihai Rimbas235, Ruxandra Patrascu15, Anda Baicus345 and for the GSSPI

Author Affiliations

1 Department of Internal Medicine, Colentina University Hospital, Soseaua Stefan cel Mare 19-21, sector 2, Bucharest, 020125, Romania

2 Department of Gastroenterology, Colentina University Hospital, Soseaua Stefan cel Mare 19-21, sector 2, Bucharest, 020125, Romania

3 Clinical Research Unit RECIF (Réseau d’ Epidémiologie Clinique International Francophone), Bucharest, Romania

4 I. Cantacuzino” National Institute of Research and Development in Microbiology-Immunology, Splaiul Independentei 103, sector 5, Bucharest, 050096, Romania

5 University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

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BMC Gastroenterology 2012, 12:86  doi:10.1186/1471-230X-12-86

Published: 9 July 2012

Abstract

Background

A tenth of patients with involuntary weight loss (IWL) have gastrointestinal cancer. Ferritin is the first parameter to be modified during the process leading to iron deficiency anaemia, therefore it should be the most sensitive. The aim of this study was to assess the ability of ferritin to rule out gastrointestinal cancer in patients with involuntary weight loss.

Methods

All consecutive patients with IWL admitted in a secondary care university hospital were prospectively studied. Ferritin, haemoglobin with erythrocyte indices and serum iron were recorded for all patients. The reference standard was bidirectional endoscopy and/or 6 months follow-up.

Results

290 patients were included, a quarter had cancer, of which 22 (7.6%) had gastrointestinal cancer (8 gastric cancer, 1 ileum cancer, 13 colorectal cancer). Ferritin had the best area under the curve (AUC), both for gastrointestinal cancer (0.746, CI: 0.691-0.794), and colorectal cancer (0.765, CI: 0.713-0.813), compared to the other parameters of iron deficiency. In the diagnosis of colorectal cancer, ferritin with a cut-off value of 100 mcg/L had a sensitivity of 93% (CI: 69-100%), and negative likelihood ratio of 0.13, with a negative predictive value of 99% (96-100%), while for gastrointestinal cancer, the sensitivity was lower (89%, CI: 67-95%), with a negative likelihood ratio of 0.24. There were three false negative patients, two with gastric cancer, and one with rectal cancer.

Conclusion

In patients with involuntary weight loss, a ferritin above 100mcg/L could rule out colon cancer, but not gastric or rectal cancer.

Keywords:
Area under the curve (AUC); Gastrointestinal cancer; Colon cancer; Ferritin; Involuntary weight loss; Sensitivity and specificity