Predictors of Outcome in Colorectal Cancer

描述（申请人提供）：2001年，预计约有135，400名美国人患结肠直肠癌，56，700人将死于该疾病。 虽然80%的患者出现在所有明显病变组织都可以手术切除的阶段，但这些患者中高达40%会复发。 肿瘤浸润深度和淋巴结状态被认为是最重要的复发预测因素，也是临床医生推荐患者术后辅助治疗的主要因素。 然而，结直肠癌患者的预后存在相当大的差异，不能用传统的预后因素来解释。 该奖项的候选人将利用两个大型随机辅助治疗试验的数据库来研究结肠癌和直肠癌预后的其他预后因素。 具体而言，这些数据库提供了一个机会，研究潜在的可修改的治疗和患者特征对短期和长期结果的影响，在患者与潜在的可治愈的结肠癌和直肠癌手术和辅助治疗。 本提案的具体目的是（1）研究医院手术量和医院特征是否影响II期和III期直肠癌患者接受根治性手术和辅助治疗的癌症复发、总生存率和治疗相关毒性，以及（2）研究饮食和生活方式对结肠癌复发和生存率的影响。 这些项目的完成将提高我们对潜在可改变因素如何影响接受根治性手术和标准辅助治疗的患者结局的理解。 这些项目将深入了解结肠癌患者的饮食和生活方式行为，以及哪些行为会影响结果。 最后，这些项目将使候选人在数据库分析和临床流行病学和健康结果研究方面获得宝贵的经验。 候选人将完成公共卫生硕士（MPH）学位和高级课程在公共卫生的哈佛学院在拟议的奖励的前两年。 这些项目将在预防和卫生服务研究方面的知名研究员查尔斯·富克斯博士的指导下进行。 在项目完成后，候选人将获得经验，成为临床流行病学和健康结果研究的独立研究人员。

DESCRIPTION (provided by applicant): In 2001, approximately 135,400 Americans are expected to develop colorectal cancer, and 56,700 individuals will die from the disease. Though 80% of patients present at a stage when all apparent diseased tissue can be surgically resected, up to 40% of these patients will suffer from recurrence. Depth of tumor invasion and nodal status are considered the most important predictors of recurrence, and are the primary factors used by clinicians in recommending to patients adjuvant therapy after surgery. However, there is considerable variation in the outcome of patients with colorectal cancer not explained by traditional prognostic factors. The candidate for this award will utilize databases from two large, randomized adjuvant therapy trials to study other prognostic factors on outcomes in colon and rectal cancer. Specifically, these databases provide an opportunity to study the influence of potential modifiable treatment and patient characteristics on short- and long-term outcomes in patients with potentially curable colon and rectal cancers treated with surgery and adjuvant therapy. The specific aims of this proposal are (1) to examine whether hospital surgical volume and hospital characteristics affect cancer recurrence, overall survival, and treatment-related toxicity in patients undergoing curative surgery and adjuvant therapy for stages II and III rectal cancer, and (2) to examine the impact of diet and lifestyle on colon cancer recurrence and survival. Completion of these projects will improve our understanding of how potentially modifiable factors affect outcomes in patients treated with curative surgery and standard adjuvant therapy. These projects will provide insight into dietary and lifestyle behaviors of patients with colon cancer and which behaviors impact outcomes. Finally, these projects will allow the candidate to gain invaluable experience in database analysis and clinical epidemiologic and health outcomes research. The candidate will complete a Masters in Public Health (MPH) degree and advanced courses at the Harvard School of Public Health during the first two years of the proposed award. The projects will be performed under the mentorship of Dr. Charles Fuchs, a well-established researcher in prevention and health services research. At the completion of the project, the candidate will have gained the experience to become an independent researcher in clinical epidemiologic and health outcomes research.