Optimizing long-term post-polypectomy surveillance for colorectal cancer prevention using a prediction rule developed from a large, community-based cohort

使用基于大型社区队列的预测规则优化长期息肉切除术后监测以预防结直肠癌

• 批准号: 9624487
• 负责人: Jeffrey Kuang Zou Lee
• 金额: $ 10.95万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-14 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9624487
• 关键词: Optimizing; long; term; post; polypectomy

PROJECT SUMMARY AND ABSTRACT The purpose of this K07 proposal is to provide Jeffrey Lee, MD, MAS with the protected time and resources to pursue the additional training needed to reach his long-term goal of becoming an independent clinical investigator, focused on colorectal cancer (CRC) prevention. Screening has been shown to reduce the incidence and mortality for CRC. However, screening has resulted in a growing cohort of patients with adenomatous polyps (adenomas) and little is known about effectively managing their post-polypectomy surveillance. With limited data available in the literature to determine the appropriate timing and frequency of follow-up colonoscopy for patients after adenoma removal, recommendations for post-polypectomy surveillance from our national guidelines have been imprecise at best. For example, the currently recommended range of 5-10 years for a surveillance colonoscopy for patients with a single adenoma covers a two-fold difference in exam frequency, with resultant two-fold impact on patient risk, cost, and colonoscopy capacity. To help optimize the timing of colonoscopic surveillance and guide appropriate utilization of this invasive and costly resource, stratification of CRC risk after colonoscopic polypectomy from a large community-based cohort with long-term follow-up is needed. Building on his prior work in CRC screening, Dr. Lee seeks to fill this knowledge gap by optimizing surveillance practices in post-polypectomy patients according to patient-, polyp-, and colonoscopy exam-related factors. Specifically, he will determine the long- term CRC risk in patients after colonoscopic polypectomy in a very large “real world” community-based population (Aim 1). He will also identify patient-, polyp-, and exam-related risk factors associated with incident CRC in these patients (Aim 2). Finally, he will develop a CRC risk prediction model that will identify post- polypectomy patients at high and low risk for developing subsequent CRC (Aim 3). To achieve these goals, Dr. Lee and his mentors have designed a career development plan for research and educational training to obtain: 1) knowledge and expertise in advanced epidemiologic methods for design and analysis of cohort studies; 2) knowledge in medical informatics methods; and 3) predictive modeling skills. To achieve the proposed research aims, Dr. Lee will leverage the rich electronic health records of Kaiser Permanente Northern California, a large community-based healthcare system, in which data on patient, physician, colonoscopy, pathology, and CRC status have been collected since 1994. In addition, Dr. Lee will use an established natural language processing tool to efficiently collect data and evaluate potential confounding variables from more than 600,000 colonoscopy reports in order to address one of the main practical challenges that have limited the feasibility of large-scale population-based studies. Thus, completion of these aims has the potential to improve prevention and early detection of CRC, impact current surveillance guidelines for post-polypectomy patients, and reduce overuse and underuse of surveillance colonoscopy. Importantly, this proposal is realistic and feasible within the award period and will allow Dr. Lee to continue to build research skills, generate preliminary data, create additional collaborative relationships, and compete for R01 funding. In summary, this K07 award will support and accelerate the career development activities of Dr. Lee and allow him to successfully launch into the next phase of his career as an independent investigator.

项目总结和摘要 本K 07提案的目的是为Jeffrey Lee，MD，MAS提供受保护的时间和资源， 追求所需的额外培训，以实现他成为一个独立的临床医生的长期目标。 研究人员，专注于结直肠癌（CRC）的预防。筛选已被证明可以减少 CRC的发病率和死亡率。然而，筛查已经导致越来越多的患者队列， 腺瘤性息肉（腺瘤）和鲜为人知的是如何有效地管理他们的息肉切除术后 监视由于文献中的数据有限，无法确定适当的时间和频率， 腺瘤切除术后患者的随访结肠镜检查，息肉切除术后的建议 我们的国家指导方针中的监测充其量是不精确的。例如，目前 对于患有单个腺瘤的患者，建议5-10年的监测结肠镜检查范围涵盖了 检查频率的两倍差异，对患者风险、成本和结肠镜检查产生双重影响 容量为了帮助优化结肠镜监测的时机，并指导适当利用这一点， 侵袭性和昂贵的资源，结肠镜息肉切除术后结直肠癌风险分层， 需要以社区为基础的队列研究和长期随访。基于他之前在CRC筛查方面的工作，Dr. Lee试图通过优化息肉切除术后患者的监测实践来填补这一知识空白 根据患者、息肉和结肠镜检查相关因素。具体来说，他将决定长期- 在一个非常大的“真实的世界”中，基于社区的结肠镜息肉切除术后患者的长期CRC风险 人口（目标1）。他还将确定与事件相关的患者，息肉和检查相关的风险因素 这些患者中的CRC（目标2）。最后，他将开发一个CRC风险预测模型，将识别后， 息肉切除术患者发生后续CRC的高风险和低风险（目标3）。为了实现这些目标，博士。 Lee和他的导师设计了一个研究和教育培训的职业发展计划，以获得： 1)掌握先进流行病学方法的知识和专业知识，用于设计和分析队列研究; 2） 医学信息学方法知识; 3）预测建模技能。为了实现拟议的 研究目标，李博士将利用丰富的电子健康记录凯撒永久北方 加州，一个大型的社区医疗保健系统，其中的病人，医生，结肠镜检查， 自1994年以来一直在收集病理学和CRC状态。此外，李博士将使用一个既定的自然 语言处理工具，以有效地收集数据和评估潜在的混淆变量，从更多 超过600，000份结肠镜检查报告，以解决限制结肠镜检查的主要实际挑战之一。 大规模人群研究的可行性。因此，完成这些目标有可能 改善CRC预防和早期发现，影响当前息肉切除术后监测指南 患者，并减少过度使用和监测结肠镜检查的使用不足。重要的是，这一建议是现实的 在奖励期内是可行的，并将使李博士能够继续培养研究技能，产生 初步数据、创建额外的协作关系并竞争R 01资金。总之，这 K 07奖将支持和加速李博士的职业发展活动，并使他能够 成功地进入了他职业生涯的下一个阶段，成为一名独立调查员。