Using medical informatics to follow-up a colorectal sessile serrated polyp cohort

使用医学信息学对结直肠无蒂锯齿状息肉队列进行随访

• 批准号: 8704474
• 负责人: Andrea Burnett-Hartman
• 金额: $ 8.8万
• 依托单位: FRED HUTCHINSON CANCER RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-04 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8704474
• 关键词: Address; Advisory Committees; Appearance; Architecture; Biometry; Caliber; Catchment Area; Characteristics; Clinic; Clinical; Cohort Studies; Colon; Colonoscopy; Colorectal; Colorectal Cancer; Colorectal Hyperplastic Polyp; Computerized Medical Record; Confidence Intervals; Consensus; Data; Data Aggregation; Development; Diagnosis; Dysplasia; Effectiveness; Excision; Future; Gastroenterology; Guidelines; High Prevalence; Histologic; Hyperplastic Polyp; Incidence; Lesion; Link; Literature; Location; Longitudinal Studies; Malignant - descriptor; Malignant Neoplasms; Medical Informatics; Medical Surveillance; Medical center; Modeling; Molecular; Molecular Profiling; Natural Language Processing; Non-Malignant; Outcome; Pathology; Pathway interactions; Patients; Polyps; Positioning Attribute; Publishing; Recommendation; Recording of previous events; Research; Research Design; Resources; Risk; Risk Estimate; Screening for cancer; Serrated Adenoma; Societies; Source; Time; Universities; Villous; Washington; adenoma; base; cancer diagnosis; cancer epidemiology; cancer risk; cohort; colorectal cancer screening; evidence base; follow-up; gastrointestinal; hazard; improved; indexing; molecular marker; mortality; neoplasm registry; patient population; population based; prevent; programs; public health relevance; screening; sound; treatment as usual; tumor progression

DESCRIPTION (provided by applicant): Recent evidence suggests that sessile serrated polyps (SSPs), flat, colonic lesions with architectural abnormalities at the base of crypts and a serrated appearance, may be important precursors to colorectal cancer. Previously, advanced adenomas were the only known polyp precursors for colorectal cancer, and SSPs were clinically grouped with hyperplastic polyps, lesions routinely believed to have no malignant potential. Now, there is growing consensus that SSPs progress to cancer along the "serrated pathway". New guidelines were developed in 2012 recommending complete removal of SSPs and increased colorectal cancer surveillance in patients with a history of SSPs. However, these guidelines acknowledge that these new recommendations are largely based on cross-sectional data, with the only longitudinal study of colorectal cancer risk in patients with SSPs limited by size (n=40). Therefore, the primary objective of this application is to gather preliminary data to estimate the risk of colorectal cancer in a large cohort of patients with clinically diagnosed SSPs. We will address the following specific aims: 1) compare the risk of subsequent colorectal cancer in patients who had SSPs diagnosed at an index colonoscopy to patients with advanced adenomas, and estimate the time to cancer progression in both polyp groups; 2) among those with SSPs at index colonoscopy, evaluate whether risk of incident colorectal cancer varies according to size and location of the index SSP. To accomplish these aims, we propose a cohort study of 2,250 patients evaluated via an index colonoscopy between 2003 and 2011 at the University of Washington Medical Center Gastroenterology Clinic and diagnosed with SSPs (N=750) or advanced adenomas (N=1,500). Using University of Washington's established Microsoft Amalga data aggregation platform, which links electronic medical records data across different sources, we have already identified our study cohort. Additional medical informatics and natural language processing will be used to electronically extract data on patient characteristics, and index polyp size and location. Then, we will electronically follow-up patients for incident colorectal cancer through December 2012 by linking our study cohort to the Puget Sound Surveillance, Epidemiology, and End Results Cancer Registry (SEER), a population based cancer registry covering western Washington State, including the catchment area for the University of Washington Medical Center Gastroenterology Clinic patient population. Cox regression models will be used to estimate hazard ratios and 95% confidence intervals of colorectal cancer risk comparing patients with SSPs to those with advanced adenomas (Aim 1) and to estimate colorectal cancer risk between patients with different polyp characteristics among those with SSPs (Aim 2). This will be the largest longitudinal study of colorectal cancer risk in patients with SSPs to date and the first study in a colonoscopy-based cohort to estimate incidence of colorectal cancer in those with SSPs diagnosed though usual care in the clinical setting.

描述(申请人提供)：最近的证据表明，无柄锯齿状息肉(SSP)是一种扁平的结肠病变，隐窝底部有结构异常，外观呈锯齿状，可能是结直肠癌的重要先兆。以前，晚期腺瘤是唯一已知的结直肠癌息肉先兆，而SSP在临床上被归类为增生性息肉，这些病变通常被认为没有恶性潜能。现在，越来越多的人达成共识，认为SSPs沿着“锯齿状路径”进展为癌症。2012年制定了新的指南，建议完全移除SSP，并加强对有SSP病史的患者的结直肠癌监测。然而，这些指南承认，这些新的建议很大程度上是基于横断面数据，仅有一项关于SSP患者结直肠癌风险的纵向研究(n=40)。因此，这项应用的主要目标是收集初步数据，以评估大量临床诊断为SSP的患者患结直肠癌的风险。我们将解决以下具体目标：1)比较在指数结肠镜检查中确诊为SSP的患者与晚期腺瘤患者的后续结直肠癌风险，并估计两组息肉患者的癌症进展时间；2)在那些在指数结肠镜下诊断为SSP的患者中，评估发生结直肠癌的风险是否因指数SSP的大小和位置而异。为了实现这些目标，我们提出了一项队列研究，对2003至2011年间在华盛顿大学医学中心胃肠病诊所通过指数结肠镜检查进行评估的2250名患者进行评估，并诊断为SSP(N=750)或晚期腺瘤(N=1,500)。使用华盛顿大学建立的微软Amalga数据聚合平台，将不同来源的电子病历数据链接起来，我们已经确定了我们的研究队列。将使用额外的医疗信息学和自然语言处理来以电子方式提取关于患者特征的数据，并为息肉大小和位置编制索引。然后，我们将对患者进行电子随访 通过将我们的研究队列与普吉特湾监测、流行病学和最终结果癌症登记处(SEER)链接，将我们的研究队列链接到2012年12月之前发生的结直肠癌，SEER是一个基于人群的癌症登记处，覆盖华盛顿州西部，包括华盛顿大学医学中心胃肠病诊所患者人口的收集区域。COX回归模型将用于评估SSP患者与晚期腺瘤患者(AIM 1)的结直肠癌风险的风险比和95%可信区间，并估计SSP患者中不同息肉特征的患者之间的结直肠癌风险(AIM 2)。这将是迄今为止规模最大的关于SSP患者的结直肠癌风险的纵向研究，也是第一项基于结肠镜检查的队列研究，以估计那些通过临床上的常规护理确诊的SSP患者的结直肠癌发病率。