Tailored Screening for Urinary System Cancers in Patients with Chronic Kidney Disease

慢性肾病患者泌尿系统癌症的定制筛查

• 批准号: 10654677
• 负责人: Stella Kang
• 金额: $ 50.58万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10654677
• 关键词: Accounting; Address; Adherence; Adult; Affect; Aftercare; Age; Anatomy; Bladder; Calibration; Cancer Burden; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Cessation of life; Chronic Kidney Failure; Classification; Clinical; Cohort Studies; Colorectal Cancer; Complex; Computer Simulation; Data Set; Detection; Diagnosis; Epidemiology; Evaluation; Event; Frequencies; General Population; Goals; Guidelines; Health; Health Status; Hypertension; Incidence; Internal Medicine; K-Series Research Career Programs; Kidney; Kidney Neoplasms; Life Expectancy; Link; Magnetic Resonance Imaging; Malignant Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of ureter; Malignant neoplasm of urinary bladder; Modeling; Monitor; Morbidity - disease rate; Natural History; Nephrology; Obesity; Outcome; Pathway interactions; Patient advocacy; Patients; Perception; Persons; Population; Population Heterogeneity; Practice Guidelines; Prevention strategy; Primary Care; Proteinuria; Public Health; Publishing; Quality of life; Quality-Adjusted Life Years; Radiology Specialty; Recommendation; Recurrence; Renal Cell Carcinoma; Renal Mass; Renal carcinoma; Renal function; Risk; Risk Factors; Science; Screening for cancer; Severities; Severity of illness; Smoking; Subgroup; Testing; Translating; Urinary system; Urinary tract; Urologic Cancer; Urologic Oncology; Urology; Urothelium; Work; aged; black men; black women; cancer risk; cardiovascular risk factor; clinical practice; comorbidity; cost; cost effective; cost effectiveness; cost estimate; experience; hazard; human old age (65+); improved; middle age; models and simulation; mortality; mortality risk; patient subsets; screening; screening guidelines; ultrasound; urinary; young man

Project Summary Chronic kidney disease (CKD) is a highly prevalent condition, found in 20% of people aged 50 years and older. While it is well known that CKD is strongly associated with cardiovascular mortality, recent work has demonstrated an association with cancer risk that also merits consideration for preventive strategies. Cancer is the leading cause of death in mid-life patients afflicted by early stages of CKD, and the 2nd leading cause across all CKD patients under 65 years. Specifically, kidney cancers occur three times more often in patients with CKD, including a hazard ratio of up to 3.4 in younger men (40-52 years) with moderate CKD (15-60 mL/min/1.73 m2). Indeed, the incidence of kidney cancer in mid-life patients with CKD is similar to that of colorectal cancer in the general population. Risks of bladder cancer are similarly increased in CKD. Current guidelines recommend that CKD patients undergo monitoring of common renal and cardiovascular risk factors that overlap with those of urinary tract cancers such as smoking, hypertension, and obesity. Thus, the lack of clear cancer screening recommendations represents an important gap in CKD practice guidelines, and may be due to the complex weighing of benefits and harms for a population with wide-ranging health status. Our team of experts in decision science, epidemiology, urologic oncology, nephrology, radiology, and internal medicine will apply complementary experience to assess the potential of screening strategies. We previously developed and published a computer simulation model of kidney tumors and comorbidities, supported by an NCI K award, the Renal Anatomy and Function for Renal Masses (Re-AFFiRM) simulation model. Our model is capable of simulating outcomes of subpopulations defined by CKD severity and kidney tumor natural history. We will transform the model to incorporate bladder cancer natural history as well as kidney and bladder screening pathways. We will assess whether cancer screening pathways benefit life expectancy and quality-adjusted life expectancy based on age, CKD stage, strong co-existing risk factors, and comorbidity burden. Middle-aged adults without other significant cardiovascular comorbidity and multiple established risk factors may warrant more intensive screening, whereas patients with cardiovascular disease and few risk factors may warrant less intensive screening. In addition, Black men and women with CKD have been shown repeatedly to suffer higher all-cause and cancer-specific mortality compared to non-Black CKD patients, an important consideration in forming screening recommendations. Our findings will be evaluated by a group of independent stakeholders in primary care, nephrology, urology, and patient advocacy to consider the acceptability and barriers to screening as supported by the model results. Cost-effectiveness will also be explored for key factors that affect or elevate the value of screening. Our goal will be to establish the context in which urinary tract screening recommendations could benefit the large population with CKD.

项目摘要 慢性肾脏疾病（CKD）是一种高度流行的疾病，在20%的50岁以上的人群中发现， 老了虽然众所周知CKD与心血管死亡率密切相关，但最近的研究表明， 研究表明，与癌症风险有关，也值得考虑预防策略。癌症是 是CKD早期中年患者死亡的主要原因， 所有65岁以下的CKD患者。具体来说，肾癌的发生率是其他癌症患者的三倍。 CKD患者，包括中度CKD（15-60）的年轻男性（40-52岁）的风险比高达3.4 mL/min/1.73 m2）。事实上，CKD中年患者的肾癌发病率与 结直肠癌的发病率。CKD患者患膀胱癌的风险也同样增加。电流 指南建议CKD患者接受常见肾脏和心血管风险因素的监测， 与吸烟、高血压和肥胖等泌尿道癌症的症状重叠。因此，缺乏 明确的癌症筛查建议是CKD实践指南中的一个重要空白， 由于对健康状况广泛的人群的利益和危害的复杂权衡。 我们的决策科学、流行病学、泌尿肿瘤学、肾脏病学、放射学和 内科将运用补充经验来评估筛查策略的潜力。我们 先前开发并发表了肾脏肿瘤和合并症的计算机模拟模型， 在NCI K奖的支持下，肾脏肿块的肾脏解剖和功能（Re-AFFiRM）模拟 模型我们的模型能够模拟由CKD严重程度和肾功能定义的亚群的结果。 肿瘤自然史我们将改变模型，以纳入膀胱癌自然史以及 肾脏和膀胱筛查途径。我们将评估癌症筛查途径是否有益于生命 基于年龄、CKD分期、强共存风险因素的预期寿命和质量调整预期寿命，以及 共同负担。无其他显著心血管合并症和多种 已确定的风险因素可能需要更密集的筛查，而心血管疾病患者 并且很少有风险因素可以保证不太密集的筛查。此外，患有CKD的黑人男女 与非黑人CKD相比，一再被证明具有更高的全因和癌症特异性死亡率 患者，形成筛选建议的重要考虑因素。我们的研究结果将由 一组独立的利益相关者在初级保健，肾脏病学，泌尿学，和病人的宣传考虑 模型结果支持的可接受性和筛选障碍。成本效益也将是 探索影响或提高筛查价值的关键因素。我们的目标将是建立在 哪种尿路筛查建议可以使大量CKD患者受益。