Evaluation of genetic, clinical, and environmental risk factors to establish effective screening strategies for second primary lung cancer

评估遗传、临床和环境危险因素，建立第二原发性肺癌的有效筛查策略

• 批准号: 10394712
• 负责人: Summer S Han
• 金额: $ 57.44万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10394712
• 关键词: Adoption; Advisory Committees; Age; Area; Body mass index; Cancer Etiology; Cancer Model; Cancer Survivor; Cessation of life; Characteristics; Chronic Obstructive Pulmonary Disease; Clinical; Clinical Data; Consensus; Consensus Development; Cost Analysis; Cost Savings; Data; Databases; Decision Making; Development; Diagnosis; Education; Environmental Risk Factor; Etiology; Evaluation; Exposure to; Gender; General Population; Genetic; Genetic Risk; Goals; Guidelines; Hazard Models; Health; Health Policy; Healthcare Systems; Histology; Incidence; Individual; International; Life; Lung; Malignant neoplasm of lung; Medicare; Methods; Modeling; Molecular; Molecular Epidemiology; Morbidity - disease rate; Oncology; Patients; Population; Preventive measure; Preventive service; Procedures; Public Health; Quality-Adjusted Life Years; Race; Radiation; Radiology Specialty; Research; Research Personnel; Risk; Risk Factors; Role; SEER Program; Savings; Screening for cancer; Selection Criteria; Single Nucleotide Polymorphism; Smoking; Time; Translating; Uncertainty; X-Ray Computed Tomography; base; cancer risk; clinical risk; cohort; computed tomography screening; cost; cost effectiveness; cost estimate; follow-up; high risk; life time cost; lung cancer screening; models and simulation; mortality; multidisciplinary; payment; population based; predictive modeling; programs; risk prediction model; screening; screening guidelines; sex; standard of care; statistics; tool

Lung cancer (LC) is a leading cause of cancer deaths in the U.S. The widespread adoption of computed tomography (CT) screening enables the early detection of lung cancer and is expected to increase the number of long-term LC survivors. The estimated number of LC survivors is approximately 412,230 as of 2012 and is projected to be over a half million in 2022. Recent studies show that LC survivors have a high risk of developing second primary lung cancer (SPLC), the incidence of which is around 4-6 times higher than that of initial primary lung cancer (IPLC) in the general population. While national lung screening guidelines have been established for IPLC by the U.S. Preventive Services Task Force (USPSTF), no such consensus guidelines exist for LC survivors who are exposed to a high risk of SPLC. Furthermore, the factors that contribute to the development of SPLC have not yet been established. Our long-term goal is to reduce the overall LC mortality in the U.S. population by focusing on SPLC. The overall objectives of this application are to identify the genetic, clinical, and environmental determinants for SPLC, to assess an individual’s risk of developing SPLC, and to evaluate efficient lung screening strategies for SPLC to help inform the development of consensus screening guidelines for LC survivors. Our aims are: (AIM 1) To identify the genetic, environmental, clinical, and demographic risk factors for SPLC and to develop a risk prediction model for SPLC. We will use cohort data from the Transdisciplinary Research in Cancer of the Lung (TRICL) and the International Lung Cancer Consortium (ILCCO) to evaluate risk factors for SPLC; (AIM 2) To evaluate optimal CT screening strategies for SPLC by estimating the population-level harms and benefits of CT screening under various selection criteria. We will develop a stochastic simulation model for SPLC that integrates the incidence, progression, and survival of SPLC to quantify the population-level harms and benefits of screening for SPLC under various risk- based selection criteria; (AIM 3) To estimate the lifetime costs and to assess the cost-effectiveness of CT screening strategies for SPLC in the general U.S. population. The contribution of our research will be significant because it will provide a better understanding of the etiology of SPLC by identifying various risk factors for SPLC using comprehensive population-based data. Second, the completion of our research will provide a valuable decision tool for evaluating an individual’s risk of developing SPLC, which can help identify high-risk individuals for screening. Finally, by evaluating the potential harms and benefits of lung cancer screening for SPLC under various criteria, our research will provide a set of optimal CT screening strategies, the results of which will reduce clinicians’ uncertainty on how to best guide LC survivors for CT screening.

肺癌（LC）是美国癌症死亡的主要原因 断层扫描（CT）筛查可以早期检测到肺癌，并有望增加数量 长期LC存活。截至2012年，估计的LC存活次数约为412,230 预计在2022年将超过500万。最近的研究表明，LC表面有高风险 发展第二个原发性肺癌（SPLC），该肺癌的事件大约是 一般人群中的初始原发性肺癌（IPLC）。尽管国家肺筛查指南已经 由美国预防服务工作组（USPSTF）为IPLC建立，没有此类共识指南 存在于暴露于SPLC高风险的LC幸存者中。此外，导致的因素 SPLC的发展尚未建立。我们的长期目标是降低整体LC死亡率 在美国人口中，专注于SPLC。本应用程序的总体目标是确定 SPLC的遗传，临床和环境决定者，以评估个人发展SPLC的风险， 并评估SPLC的有效肺部筛查策略，以帮助开发共识 LC存活的筛查指南。我们的目标是：（目标1）确定遗传，环境，临床， 以及SPLC的人口统计风险因素，并为SPLC开发风险预测模型。我们将使用队列 来自肺癌跨学科研究（TRICL）和国际肺癌的数据 财团（ILCCO）评估SPLC的危险因素； （目标2）评估最佳CT筛选策略 通过估计各种选择下的CT筛查的人口级危害和益处，用于SPLC 标准。我们将为SPLC开发一个随机仿真模型，该模型整合了事件，进展和 SPLC的生存以量化在各种风险下对SPLC筛查的人口级危害和益处 基于选择标准； （目标3）估计终身成本并评估CT的成本效益 美国普通人群中SPLC的筛选策略。我们的研究的贡献将是 意义重大，因为它可以通过识别各种风险来更好地理解SPLC的病因 使用综合基于人群的数据的SPLC因素。第二，我们的研究完成将 提供一个有价值的决策工具来评估个人患SPLC的风险，这可以帮助识别 高危个人进行筛查。最后，通过评估肺癌的潜在危害和益处 在各种标准下对SPLC进行筛选，我们的研究将提供一组最佳的CT筛选策略， 结果将减少临床医生对如何最好地指导LC表面进行CT筛查的不确定性。