Evaluation of genetic, clinical, and environmental risk factors to establish effective screening strategies for second primary lung cancer

评估遗传、临床和环境危险因素，建立第二原发性肺癌的有效筛查策略

• 批准号: 9912737
• 负责人: Summer S Han
• 金额: $ 60.59万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9912737
• 关键词: Adoption; Advisory Committees; Age; Area; Cancer Etiology; Cancer Model; Cancer Survivor; Cessation of life; Characteristics; Chronic Obstructive Airway Disease; Clinical; Clinical Data; Consensus; Consensus Development; Cost Analysis; Cost Savings; Data; Databases; Decision Making; Development; Diagnosis; Education; Environmental Risk Factor; Etiology; Evaluation; Exposure to; Gender; General Population; Genetic; Genetic Risk; Goals; Guidelines; Hazard Models; Health; Health Policy; Healthcare Systems; Histology; Incidence; Individual; International; Life; Lung; Malignant neoplasm of lung; Medicare; Methods; Modeling; Molecular; Molecular Epidemiology; Morbidity - disease rate; Oncology; Patients; Population; Preventive measure; Preventive service; Procedures; Public Health; Quality-Adjusted Life Years; Race; Radiation; Radiology Specialty; Research; Research Personnel; Risk; Risk Factors; Role; SEER Program; Savings; Screening for cancer; Selection Criteria; Single Nucleotide Polymorphism; Smoking; Time; Translating; Uncertainty; X-Ray Computed Tomography; base; cancer risk; clinical risk; cohort; computed tomography screening; cost; cost effectiveness; cost estimate; follow-up; high risk; life time cost; lung cancer screening; models and simulation; mortality; multidisciplinary; payment; population based; predictive modeling; programs; risk prediction model; screening; screening guidelines; sex; standard of care; statistics; tool

Lung cancer (LC) is a leading cause of cancer deaths in the U.S. The widespread adoption of computed tomography (CT) screening enables the early detection of lung cancer and is expected to increase the number of long-term LC survivors. The estimated number of LC survivors is approximately 412,230 as of 2012 and is projected to be over a half million in 2022. Recent studies show that LC survivors have a high risk of developing second primary lung cancer (SPLC), the incidence of which is around 4-6 times higher than that of initial primary lung cancer (IPLC) in the general population. While national lung screening guidelines have been established for IPLC by the U.S. Preventive Services Task Force (USPSTF), no such consensus guidelines exist for LC survivors who are exposed to a high risk of SPLC. Furthermore, the factors that contribute to the development of SPLC have not yet been established. Our long-term goal is to reduce the overall LC mortality in the U.S. population by focusing on SPLC. The overall objectives of this application are to identify the genetic, clinical, and environmental determinants for SPLC, to assess an individual’s risk of developing SPLC, and to evaluate efficient lung screening strategies for SPLC to help inform the development of consensus screening guidelines for LC survivors. Our aims are: (AIM 1) To identify the genetic, environmental, clinical, and demographic risk factors for SPLC and to develop a risk prediction model for SPLC. We will use cohort data from the Transdisciplinary Research in Cancer of the Lung (TRICL) and the International Lung Cancer Consortium (ILCCO) to evaluate risk factors for SPLC; (AIM 2) To evaluate optimal CT screening strategies for SPLC by estimating the population-level harms and benefits of CT screening under various selection criteria. We will develop a stochastic simulation model for SPLC that integrates the incidence, progression, and survival of SPLC to quantify the population-level harms and benefits of screening for SPLC under various risk- based selection criteria; (AIM 3) To estimate the lifetime costs and to assess the cost-effectiveness of CT screening strategies for SPLC in the general U.S. population. The contribution of our research will be significant because it will provide a better understanding of the etiology of SPLC by identifying various risk factors for SPLC using comprehensive population-based data. Second, the completion of our research will provide a valuable decision tool for evaluating an individual’s risk of developing SPLC, which can help identify high-risk individuals for screening. Finally, by evaluating the potential harms and benefits of lung cancer screening for SPLC under various criteria, our research will provide a set of optimal CT screening strategies, the results of which will reduce clinicians’ uncertainty on how to best guide LC survivors for CT screening.

肺癌 (LC) 是美国癌症死亡的主要原因。 断层扫描 (CT) 筛查能够早期发现肺癌，并有望增加肺癌数量 长期 LC 幸存者。截至 2012 年，估计 LC 幸存者人数约为 412,230 人， 预计到 2022 年将超过 50 万。最近的研究表明，LC 幸存者有很高的风险 发展为第二原发性肺癌（SPLC），其发病率比非原发性肺癌高约4-6倍 一般人群中的初始原发性肺癌（IPLC）。虽然国家肺部筛查指南已 由美国预防服务工作组 (USPSTF) 为 IPLC 制定，没有此类共识指南 存在于 SPLC 高风险的 LC 幸存者中。此外，影响因素 SPLC 的开发尚未建立。我们的长期目标是降低 LC 总体死亡率 通过关注 SPLC 来影响美国人口。该应用程序的总体目标是确定 SPLC 的遗传、临床和环境决定因素，以评估个体发生 SPLC 的风险， 评估 SPLC 的有效肺部筛查策略，以帮助达成共识 LC 幸存者筛查指南。我们的目标是：（AIM 1）识别遗传、环境、临床、 以及 SPLC 的人口统计风险因素，并开发 SPLC 的风险预测模型。我们将使用队列 数据来自肺癌跨学科研究 (TRICL) 和国际肺癌 评估 SPLC 风险因素的联盟 (ILCCO)； (目标 2) 评估最佳 CT 筛查策略 通过估计各种选择下 CT 筛查对人群水平的危害和益处，对 SPLC 进行评估 标准。我们将为 SPLC 开发一个随机模拟模型，该模型集成了发病率、进展和 SPLC 的生存，以量化在各种风险下筛查 SPLC 的人群水平危害和益处 基于选择标准； （目标 3）估算 CT 的生命周期成本并评估其成本效益 美国普通人群中 SPLC 的筛查策略。我们研究的贡献将是 意义重大，因为它将通过识别各种风险来更好地了解 SPLC 的病因 使用基于人群的综合数据进行 SPLC 的因素。第二，我们的研究的完成将 提供一个有价值的决策工具来评估个人发展 SPLC 的风险，这可以帮助识别 高危人群进行筛查。最后，通过评估肺癌的潜在危害和益处 在各种标准下筛查SPLC，我们的研究将提供一套最佳的CT筛查策略， 其结果将减少临床医生对如何最好地指导 LC 幸存者进行 CT 筛查的不确定性。