Reducing Colorectal Cancer Disparities: Racial Differences in Colorectal Polyp Profile

减少结直肠癌差异：结直肠息肉特征的种族差异

• 批准号: 9343096
• 负责人: Sudha Xirasagar
• 金额: $ 12.83万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9343096
• 关键词: 10 year old; Accounting; Age; Age-Years; Anatomy; Autopsy; Cancer Etiology; Caring; Carpet; Cessation of life; Characteristics; Clinical; Clinical Trials; Cluster Analysis; Colonoscopy; Colorectal; Colorectal Cancer; Colorectal Polyp; Conduct Clinical Trials; Data; Data Set; Data Sources; Databases; Depressed mood; Diagnosis; Diagnostic; Disease; Distal; Documentation; Dysplasia; Frequencies; Funding; Gender; General Population; Gold; Guidelines; Health; Histology; Hyperplasia; Incidence; Lesion; Link; Literature; Location; Logistic Regressions; Malignant Neoplasms; Morphology; Outcome; Patients; Phase; Polynomial Models; Polyps; Population; Precancerous Polyp; Premalignant; Prevalence; Proxy; Race; Recommendation; Registries; Research; Sampling; Series; South Carolina; Stage at Diagnosis; Staging; Survival Rate; Testing; Tubular formation; United States; United States National Institutes of Health; Villous; adenoma; age group; age related; aged; cancer diagnosis; cancer health disparity; cancer risk; cancer survival; cohort; early experience; evidence base; experience; follow-up; male; mortality; mortality disparity; neoplasm registry; racial difference; racial disparity; screening

 DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the second leading cause of cancer and cancer deaths in the United States, about 136,000 new cases diagnosed and 50,000 dying from the disease each year. CRC racial disparities (26% higher incidence among Blacks and 52% higher mortality) have persisted at pre-2000 levels despite significant strides in population-wide colonoscopy screening. Nearly 60% of both Whites and Blacks are now covered by colonoscopy screening. Current screening recommendations (initiation of screening at 50 years of age regardless of race) are driven by an assumption that the prevailing CRC disparities are largely due to differences in access to screening and the quality of post diagnostic care. However, in younger age groups, Blacks have twice the CRC incidence rate as Whites, and their stage- adjusted CRC survival rates are lower than Whites. Assuming that most CRCs arise from precancerous polyps that evolve into cancer, it is plausible that Blacks experience earlier polyp initiation and more rapid polyp progression to cancer. If such is the case, one potential factor in the persistent CRC disparities may be the race-neutral age guideline for screening initiation. However there is no direct evidence regarding age-related Black-White differences in precancerous polyps and the indicators of progression through the intermediate stages (polyp size and dysplastic histology). To establish such evidence, it requires a data source representing the polyp prevalence and profile in the population. In the absence of a large enough autopsy study, the next best alternative is a colonoscopy series validated to have achieved near-complete polyp clearance, and having complete polyp documentation. No such data source has been available so far. Our study will leverage a unique polyp database generated by a previous NIH-funded study. It represents the nearest possible proxy to the population polyp prevalence and profile, and has sufficient statistical power to compare Blacks and Whites on polyp prevalence and cancer-relevant features within age strata. It is a large and well-documented database of a single-center colonoscopy series which is externally validated to have achieved near-complete polyp clearance: this cohort experienced 83% CRC incidence reduction and 89% CRC mortality reduction relative to the general South Carolina population over a 4.9-year of follow-up period. The rates are similar to those of the only colonoscopy clinical trial so far. We will use data on ~17,681 colonoscopy patients with ~32,900 polyps (54% Black), and CRC data on this cohort obtained from the South Carolina Central Cancer Registry. We will study Black-White differences within 5-10 year age strata in: the presence of polyps, polyp number and features (size, histology, anatomic location, dysplasia status, and cancer), as well as combinations of these factors. We will use univariate statistical tests, multiple regressio (binary and ordered polynomial logistic regression, linear and Poisson regression) and cluster analysis. We will use sensitivity analyses to account for potential bias in the sample.

 描述（由申请人提供）：结直肠癌（CRC）是美国癌症和癌症死亡的第二大原因，每年约有136，000例新诊断病例和50，000例死于该疾病。CRC的种族差异（黑人发病率高26%，死亡率高52%）一直保持在2000年前的水平，尽管人口范围的结肠镜检查筛查取得了重大进展。近60%的白人和黑人现在都接受了结肠镜检查。目前的筛查建议（在50岁时开始筛查，不分种族）是由一个假设驱动的，即普遍存在的CRC差异主要是由于筛查和诊断后护理质量的差异。 然而，在较年轻的年龄组中，黑人的CRC发病率是白人的两倍，并且他们的阶段调整的CRC生存率低于白人。假设大多数CRC是由癌前息肉演变成癌症引起的，那么黑人经历更早的息肉开始和更快的息肉发展成癌症是合理的。如果是这种情况，持续CRC差异的一个潜在因素可能是筛选开始的种族中立年龄指南。然而，没有直接证据表明癌前息肉的年龄相关性黑白差异和通过中间阶段的进展指标（息肉大小和发育不良组织学）。为了建立这样的证据，它需要一个代表息肉患病率和人口概况的数据源。在缺乏足够大的尸检研究的情况下，下一个最好的选择是结肠镜检查系列，经验证已达到接近完全的息肉清除，并有完整的息肉文件。迄今为止还没有这样的数据来源。 我们的研究将利用以前NIH资助的研究生成的独特息肉数据库。它代表了人群息肉患病率和特征的最接近的可能代理，并且具有足够的统计功效来比较年龄层内黑人和白人的息肉患病率和癌症相关特征。这是一个大型且记录良好的单中心结肠镜检查系列数据库，经外部验证已实现息肉几乎完全清除：在4.9年的随访期内，相对于一般南卡罗来纳州人群，该队列的CRC发病率降低了83%，CRC死亡率降低了89%。该比率与迄今为止唯一的结肠镜临床试验相似。 我们将使用约17，681例结肠镜检查患者的数据，其中约32，900例息肉（54%为黑人），以及从南卡罗来纳州中央癌症登记处获得的该队列的CRC数据。我们将研究5-10岁年龄段内的黑白差异：息肉的存在、息肉数量和特征（大小、组织学、解剖位置、异型增生状态和癌症），以及这些因素的组合。我们将使用单变量统计检验，多元回归（二元和有序多项式逻辑回归，线性和泊松回归）和聚类分析。我们将使用敏感性分析来解释样本中的潜在偏倚。