Validation of a risk assessment decision rule for epithelial ovarian cancer

上皮性卵巢癌风险评估决策规则的验证

• 批准号: 8571907
• 负责人: Nicole Denise Urban
• 金额: $ 22.97万
• 依托单位: FRED HUTCHINSON CANCER RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-16 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8571907
• 关键词: BRCA2 Mutation; Bilateral; CA-125 Antigen; Classification; Clinical; Clinical Trials; Colon; Data; Data Collection; Development; Disease; Early Intervention; Epidemiology; Epithelial ovarian cancer; Excision; Future; Goals; High Risk Woman; Image; Lesion; Lung; Malignant Neoplasms; Malignant neoplasm of ovary; Mammalian Oviducts; Measurement; Modeling; Mutation; Nested Case-Control Study; Observational Study; Operative Surgical Procedures; Ovarian; Ovary; Performance; Population; Population Study; Postmenopause; Prevalence; Prevention; Prevention strategy; Process; Prospective Studies; Prostate; Publishing; Recommendation; Relative Risks; Research; Risk; Risk Assessment; Risk Factors; Risk Reduction; Salpingo-Oophorectomy; Sampling; Serous; Serum Markers; Study of serum; Time; Tubal Excisions; Validation; WFDC2 gene; Woman; Women' s Group; Women' s Health; Work; base; cohort; common rule; design; epidemiologic data; fimbria; high risk; improved; innovation; lifetime risk; mortality; mutation carrier; ovarian cancer prevention; prevent; prophylactic; prospective; public health relevance; routine care; screening; tool

DESCRIPTION (provided by applicant): Our goal is to develop a risk-classification tool to identify post-menopausal women who are at high or elevated risk for epithelial ovarian cancer (EOC). We will develop and validate a risk-assessment decision rule based on serum markers CA125 and HE4 as well as epidemiologic risk factors using a split-sample design and data from the Women's Health Initiative (WHI) Observational Study (OS), the WHI Clinical Trial (CT) and the Prostate, Lung, Colon and Ovary (PLCO) trial. A decision rule developed as preliminary work identified 10%- 13% of all post-menopausal women as elevated risk and predicted 26%-58% of cases. Surgical prevention consisting of prophylactic removal of fallopian tubes (FTs) and ovaries is recognized as the best approach to prevent epithelial ovarian cancer (EOC) and especially high grade serous cancer (HGSC) in high-risk women. We will develop a tool to categorize women into risk classifications that have clear clinical implications including recommendations for surgical prevention, imaging, surveillance and routine care. In the first 2 aims we will focus on development of the epidemiologic portion of the model because the serum marker portion of the decision rule has already been developed based on extensive published work. In Aim 3 we will validate the final decision rule that combines epidemiologic risk factors with serum markers. We operationally define high risk as relative risk (RR) of at least 6, and elevated risk as RR of at least 2. Aim 1: Using a randomly selected fraction of women participating in the WHI OS, WHI CT and the PLCO trial, develop decision rules to identify women at elevated risk for EOC and HGSC using epidemiologic variables alone. Using the remaining women from each study, validate each decision rule within each population. Decision rules developed in this aim will be specific to each study population in order to take advantage of all of the epidemiologic data collected by each study. Aim 2: Cross-validate the decision rules developed in Aim 1 to identify the rule that best identifies women at elevated risk for EOC and HGSC across the 3 different populations. This will require refinement of the decision rules to accommodate differences in data collection across the cohorts. The study fraction used for development will be used to identify the best common rule, and cross-validation will employ the remaining validation fraction of women participating in the WHI OS, WHI CT and the PLCO trial. This aim will identify the best epidemiologic decision rule for use in the overall decision rule to be validated in Aim 3. Aim 3: Using nested case-control study serum marker data as well as epidemiologic data from each study, validate the best decision rule from Aim 2 in combination with the serum marker component of the rule to identify women at elevated- and high-risk for EOC and HGSC in each of those populations. In this aim we will validate the final decision rule that incorporates both epidemiologic risk factors and serum markers.

描述（由申请人提供）：我们的目标是开发一种风险分类工具，以识别具有高风险或高危上皮性卵巢癌（EOC）的绝经后妇女。我们将使用分样本设计和来自妇女健康倡议（WHI）观察性研究（OS）、WHI临床试验（CT）和前列腺、肺、结肠和卵巢（PLCO）试验的数据，开发并验证基于血清标志物CA125和HE4以及流行病学危险因素的风险评估决策规则。作为初步工作制定的一项决策规则确定，10%- 13%的绝经后妇女存在高风险，并预测26%-58%的病例。包括输卵管（FTs）和卵巢的预防性切除的手术预防被认为是预防高危女性上皮性卵巢癌（EOC），特别是高级别浆液性癌（HGSC）的最佳方法。我们将开发一种工具，对妇女进行风险分类，这些分类具有明确的临床意义，包括对手术预防、成像、监测和常规护理的建议。在前两个目标中，我们将重点关注模型的流行病学部分的开发，因为决策规则的血清标记部分已经基于大量已发表的工作而开发。在目标3中，我们将验证将流行病学危险因素与血清标志物相结合的最终决策规则。我们在操作上将高风险定义为相对风险（RR）至少为6，高风险定义为RR至少为2。目标1：使用随机选择的一部分参加WHI OS、WHI CT和PLCO试验的妇女，制定决策规则，仅使用流行病学变量来识别EOC和HGSC风险升高的妇女。使用每个研究中剩余的女性，验证每个人群中的每个决策规则。为此目的制定的决策规则将针对每个研究人群，以便利用每项研究收集的所有流行病学数据。目标2：交叉验证目标1中制定的决策规则，以确定在3个不同人群中最能识别EOC和HGSC高风险女性的规则。这将需要改进决策规则，以适应不同群组的数据收集差异。用于开发的研究部分将用于确定最佳共同规则，交叉验证将采用参与WHI OS， WHI CT和PLCO试验的剩余女性验证部分。这一目标将确定在总体决策规则中使用的最佳流行病学决策规则