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: 9224101
• 负责人: Jeffrey Kuang Zou Lee
• 金额: $ 17.71万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 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/9224101
• 关键词: Address; Adenomatous Polyps; Adherence; Age; Award; California; Cancer Etiology; Cancerous; Cessation of life; Chemopreventive Agent; Clinical Investigator; Cohort Studies; Colonoscopy; Colorectal Cancer; Communities; Confounding Factors (Epidemiology); DNA; Data; Development; Development Plans; Electronic Health Record; Epidemiologic Methods; Excision; Frequencies; Funding; Future; Goals; Grant; Guidelines; Health Care Costs; Healthcare Systems; Incidence; Knowledge; Lead; Link; Literature; Medical Informatics; Mentors; Mentorship; Methods; Modeling; National Cancer Institute; Natural Language Processing; Outcome; Pathology; Patient risk; Patients; Phase; Physicians; Policies; Polypectomy; Polyps; Population; Prevention; Randomized Controlled Trials; Recommendation; Regimen; Reporting; Research; Research Personnel; Resources; Risk; Risk Factors; Scheme; Stratification; Surveillance Program; Testing; Time; Training; United States; United States National Institutes of Health; Work; Writing; adenoma; base; cancer risk; career; career development; cohort; colorectal cancer prevention; colorectal cancer screening; community based participatory research; cost; design; evidence base; follow-up; high risk; improved; mortality; multidisciplinary; population based; predictive modeling; screening; skills; surveillance strategy; tool

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.

项目摘要和摘要 此K07提案的目的是为Jeffrey Lee，MD，MAS提供受保护的时间和资源，以 继续进行必要的额外培训，以实现他成为一名独立诊所的长期目标 研究员，专注于结直肠癌(CRC)的预防。已有研究表明，筛查可以减少 结直肠癌的发病率和死亡率。然而，筛查导致越来越多的患者患有 腺瘤性息肉(腺瘤)，对息肉切除术后的有效处理知之甚少 监视系统。利用文献中可用的有限数据来确定适当的定时和频率 腺瘤切除后患者的随访结肠镜检查，息肉切除后的建议 根据我们的国家指导方针进行的监控充其量也是不准确的。例如，当前 对单发腺瘤患者进行结肠镜检查的建议范围为5-10年，包括 检查频率相差两倍，从而对患者风险、成本和结肠镜检查产生双重影响 容量。帮助优化结肠镜检查的时机，并指导对其的适当使用 侵入性和昂贵的资源：结肠镜下息肉切除术后结直肠癌风险的分层 需要以社区为基础的队列，并进行长期跟踪。在他之前在结直肠癌筛查工作的基础上， 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。具体地说，他将决定长期- 结肠镜息肉切除术后患者的长期结直肠癌风险：一项基于社区的非常大的“真实世界”研究 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 这些患者的结直肠癌(目标2)。最后，他将开发一个CRC风险预测模型，该模型将识别后 息肉切除术患者发生继发性结直肠癌的风险分别为高风险和低风险(目标3)。为了实现这些目标，Dr。 Lee和他的导师为研究和教育培训设计了职业发展计划，以获得： 1)在设计和分析队列研究的先进流行病学方法方面的知识和专业知识；2) 具有医学信息学方法方面的知识；3)预测建模技能。要实现建议的 研究目标，李博士将利用Kaiser Permanente Northern丰富的电子健康记录 加利福尼亚，一个大型的基于社区的医疗保健系统，在其中，患者、医生、结肠镜检查、 病理和结直肠癌状况自1994年以来一直在收集。此外，李博士将使用一种既定的自然 一种语言处理工具，可高效收集数据并评估潜在的混杂变量 60多万份结肠镜检查报告，以解决限制 大规模人口研究的可行性。因此，完成这些目标有可能 加强对结直肠癌的预防和早期发现，影响目前息肉切除术后的监测指南 减少过度使用和不充分使用监视结肠镜检查。重要的是，这个建议是现实的。 并在获奖期内可行，并将使李博士继续建立研究技能，产生 初步数据，创建其他协作关系，并竞争R01资金。总而言之，这是 K07奖将支持和加速李博士的职业发展活动，并允许他 作为一名独立调查员，他成功地进入了职业生涯的下一个阶段。