Optimizing Colorectal Cancer and Polyp Surveillance after Colorectal Polypectomy

优化结直肠息肉切除术后结直肠癌和息肉监测

基本信息

  • 批准号:
    10011577
  • 负责人:
  • 金额:
    --
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2015
  • 资助国家:
    美国
  • 起止时间:
    2015-04-01 至 2019-09-30
  • 项目状态:
    已结题

项目摘要

 DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the 2nd leading cause of cancer death nationally, and the 3rd most commonly diagnosed cancer among Veterans. To reduce cancer risk, small growths in the colon called polyps found at colonoscopy are routinely removed. Current guidelines recommend repeat colonoscopy in 3, 5, or 10 years based on select features of polyps removed. However, the current approach is not accurate for cancer risk prediction. Late colonoscopy (in 5 or 10 years) is often recommended for individuals who go on to develop cancer or high-risk polyps. Conversely, early colonoscopy (in 3 years) is often recommended for individuals who go on to develop only low-risk findings. The result is suboptimal cancer prevention. The overall goal of this project is to develop a new, more personalized and comprehensive strategy for assessing risk for new polyps and CRC after initial polyp removal, including patient factors (such as age), baseline polyp factors (such as number, size, location), and quality factors (such as average polyp detection rate of the doctor performing colonoscopy). To develop the strategy, national VA colonoscopy and medical record data will be accessed to identify Veterans who have had polyp removal and at least one follow up colonoscopy between 1999 and 2012. At least 30,000 Veterans are expected to meet these criteria. Next, computerized Natural Language Processing (NLP) techniques will be developed to extract risk and outcome data of interest from colonoscopy and pathology records. These innovative techniques are required because the most valuable information available for risk prediction is only available in "free text" format witin these clinical reports. The alternative approach to data extraction (manual review of each Veteran's medical chart) is impractical, and indeed it is for this reason that research in this are has previously not been possible on a large-scale. Application of these NLP techniques will allow creation of a large, representative dataset of all Veterans who have had colonoscopy with polyp removal. In the third part of this research, a statistical risk stratification strategy to prdict risk for polyps and CRC after initial polyp removal will be developed using this dataset. Performance of the new strategy will be compared to current guidelines for predicting risk for CRC and high-risk polyps after initial polyp removal. The project is significant because Veterans are at high risk for CRC, but strategies for managing cancer risk are suboptimal. The project is innovative because we will apply cutting edge NLP methods to make use of data that is representative of all Veterans who have had polyp removal within the VA, and develop risk prediction models that go beyond current guidelines by using more personalized risk measures. The research team's expertise and significant prior work specific to CRC and polyps, and the rigorous approach proposed, ensure that the project is feasible and will be successful. Ultimately, investment in this Merit Review has great potential to improve CRC prevention for Veterans, and beyond. CRITIQUE 1 1. Significance. NCCN guidelines take into account age (>50) and family history and only recommends a 10 year interval for patients without a FH and with no polyp identified or if hyperplastic polyps are identified. For patients with an adenomatous polyp removed the recommendation varies between 3 years and 5 years based on polyp number, size, and histology (villous or presence of high grade dysplasia). The assertion that colonoscopy is suboptimal for cancer prevention is in part true but primarily due to access issues and compliance with screening and less so due to surveillance intervals . The idea of a personalized interval is already in place and while a little more difficult in the veteran population, providers still make their recommendations based on individual factors in concert with national guidelines. Efforts to develop a computerized entry form to quantify and record needed information seem more important. 2. Approach It is unclear if Aim 1 will use path records to only evaluate adenomatous polyps and if so the recommendations only differ by 2 years. Accepting a low detection rate from a provider/site and/or using that as a risk factor to increase screening frequency seems like a "work around" and more direct quality interventions to monitor and raise detection rates seem more valuable. The primary endpoint consists of polyp size, polyp number and histology. The discrepancy between endoscopic visual size and pathologic size needs to worked out 3. Impact and Innovation. Given that the utilization of colon cancer screening is only around 50% nationally (2005 National Health Interview Survey) and with documented capacity issues at some VAs who have limited screening colonoscopy (fee basis) and prioritized therapeutic colonoscopy. Any study findings calling for increased screening may be unfulfilled. This study will evaluate veterans who have had at least two colonoscopies. 4. Investigator Qualifications, and Facilities and Resources. This is an experienced team. 5. Multiple PI Leadership Plan. N/A 6. Adequacy of Response to Previous Feedback Provided by HSR&D Regarding the Proposed Study. 7. Protection of Human Subjects from Research Risk. Adequate 8. Inclusion of Women and Minorities in Research. Adequate 9. Budget. Adequate 10. Overall Impression. 11. Key Strengths. 1. Colon cancer prevention is an important area. 2. Good collaborative team with extensive experience 12. Key Weaknesses. 1. This seems like a validation of NLP in a large cohort 2. Information on preventative medications such as aspirin or other dietary risks factors such as red meat consumption and BMI are not addressed
 描述(由申请人提供): 结直肠癌 (CRC) 是全国第二大癌症死亡原因,也是退伍军人中第三大最常见癌症。为了降低癌症风险,通常会切除结肠镜检查中发现的称为息肉的结肠小生长物。目前的指南建议根据切除息肉的选择特征,在 3、5 或 10 年内重复进行结肠镜检查。然而,目前的方法对于癌症风险预测并不准确。通常建议对继续发展为癌症或高危息肉的个体进行晚期结肠镜检查(5 或 10 年后)。相反,通常建议那些仅出现低风险结果的个体进行早期结肠镜检查(3 年内)。结果是癌症预防效果不佳。该项目的总体目标是制定一种新的、更加个性化和全面的策略,用于评估初次息肉切除后新发息肉和结直肠癌的风险,包括患者因素(如年龄)、基线息肉因素(如数量、大小、位置)和质量因素(如进行结肠镜检查的医生的平均息肉检出率)。 为了制定该战略,将访问国家 VA 结肠镜检查和医疗记录数据,以确定 1999 年至 2012 年间接受过息肉切除术并至少进行过一次结肠镜检查的退伍军人。预计至少有 30,000 名退伍军人符合这些标准。接下来,将开发计算机自然语言处理(NLP)技术,从结肠镜检查和病理记录中提取感兴趣的风险和结果数据。需要这些创新技术,因为可用于风险预测的最有价值的信息仅以这些临床报告中的“自由文本”格式提供。数据提取的替代方法(手动审查每位退伍军人的病历)是不切实际的,事实上,正是由于这个原因,这方面的研究以前不可能进行大规模。这些 NLP 技术的应用将允许创建一个大型的、具有代表性的数据集,其中包含所有接受过结肠镜检查并切除息肉的退伍军人。在本研究的第三部分中,将使用该数据集开发统计风险分层策略,以预测初次息肉切除后息肉和结直肠癌的风险。新策略的表现将与当前预测结直肠癌和初次息肉切除后高风险息肉风险的指南进行比较。 该项目意义重大,因为退伍军人患结直肠癌的风险很高,但管理癌症风险的策略并不理想。该项目具有创新性,因为我们将应用最先进的 NLP 方法来利用代表退伍军人管理局内所有接受过息肉切除术的退伍军人的数据,并通过使用更个性化的风险措施来开发超越当前指南的风险预测模型。研究团队的专业知识和针对 CRC 和息肉的重要前期工作,以及提出的严格方法,确保了该项目的可行性和成功。最终,对本次绩效评估的投资具有巨大的潜力,可以改善退伍军人及其他人群的结直肠癌预防。 批评 1 1. 意义。 NCCN 指南考虑了年龄 (>50) 和家族史,仅建议没有 FH、未发现息肉或发现增生性息肉的患者间隔 10 年。 对于腺瘤性息肉已切除的患者,根据息肉的数量、大小和组织学(绒毛状或存在高度不典型增生),建议在 3 年到 5 年之间变化。结肠镜检查对于癌症预防效果不佳的说法部分正确,但主要是由于准入问题和筛查依从性,其次是由于监测间隔。个性化间隔的想法已经到位,虽然还有一点点 对于退伍军人群体而言,更加困难的是,提供者仍然根据个人因素并与国家指导方针相一致地提出建议。开发计算机化的输入表格来量化和记录所需信息似乎更为重要。 2. 方法 目前尚不清楚目标 1 是否会使用路径记录仅评估腺瘤性息肉,如果是的话,建议仅相差 2 年。 接受提供商/站点的低检出率和/或将其用作增加筛查频率的风险因素似乎是一种“变通办法”,并且更直接的质量干预措施来监测和提高检出率似乎更有价值。 主要终点包括息肉大小、息肉数量和组织学。需要解决内镜视觉尺寸与病理尺寸之间的差异 3.影响和创新。 鉴于全国范围内结肠癌筛查的利用率仅为 50% 左右(2005 年全国健康访谈调查),并且一些 VA 的能力问题已记录在案,这些机构的筛查结肠镜检查(收费)和优先治疗性结肠镜检查的能力存在问题。任何要求加强筛查的研究结果都可能无法实现。 这项研究将评估至少接受过两次结肠镜检查的退伍军人。 4. 研究者资格、设施和资源。 这是一支经验丰富的团队。 5. 多个 PI 领导计划。 不适用 6. 对 HSR&D 先前提供的有关拟议研究的反馈的回应是否充分。 7. 保护人类受试者免受研究风险。 充分 8. 将妇女和少数群体纳入研究。 足够的 9. 预算。 足够 10.总体印象。 11. 主要优势。 1.结肠癌的预防是一个重要领域。 2. 良好的协作团队,经验丰富 12. 主要弱点。 1. 这似乎是 NLP 在大型队列中的验证 2. 未提及阿司匹林等预防药物或红肉摄入量和体重指数等其他饮食风险因素的信息

项目成果

期刊论文数量(32)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
Baseline Characteristics and Longitudinal Outcomes of Traditional Serrated Adenomas: A Cohort Study.
传统锯齿状腺瘤的基线特征和纵向结果:一项队列研究。
Contained colonic perforation due to cecal retroflexion.
由于盲肠后屈导致结肠穿孔。
  • DOI:
    10.3748/wjg.v22.i11.3285
  • 发表时间:
    2016
  • 期刊:
  • 影响因子:
    4.3
  • 作者:
    Geng,Zhuo;Agrawal,Deepak;Singal,AmitG;Kircher,Stephen;Gupta,Samir
  • 通讯作者:
    Gupta,Samir
Young-onset colorectal cancer risk among individuals with iron-deficiency anaemia and haematochezia.
  • DOI:
    10.1136/gutjnl-2020-321849
  • 发表时间:
    2020-12-18
  • 期刊:
  • 影响因子:
    24.5
  • 作者:
    Demb J;Liu L;Murphy CC;Doubeni CA;Martínez ME;Gupta S
  • 通讯作者:
    Gupta S
How can we boost colorectal and hepatocellular cancer screening among underserved populations?
  • DOI:
    10.1007/s11894-015-0445-1
  • 发表时间:
    2015-06-01
  • 期刊:
  • 影响因子:
    0
  • 作者:
    Goebel, Melissa;Singal, Amit G;Gupta, Samir
  • 通讯作者:
    Gupta, Samir
Spotlight: US Multi-Society Task Force on Colorectal Cancer Recommendations for Follow-up After Colonoscopy and Polypectomy.
  • DOI:
    10.1053/j.gastro.2020.02.014
  • 发表时间:
    2020-03
  • 期刊:
  • 影响因子:
    29.4
  • 作者:
    Gupta S;Lieberman D;Anderson JC;Burke CA;Dominitz JA;Kaltenbach T;Robertson DJ;Shaukat A;Syngal S;Rex DK
  • 通讯作者:
    Rex DK
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Samir Gupta其他文献

Samir Gupta的其他文献

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{{ truncateString('Samir Gupta', 18)}}的其他基金

Surveillance Colonoscopy in Older Adults: The SurvOlderAdults Study
老年人结肠镜检查监测:SurvOlderAdults 研究
  • 批准号:
    10638065
  • 财政年份:
    2023
  • 资助金额:
    --
  • 项目类别:
CRC-HUB-SPOKE: A ColoRectal Cancer screening Hub for Southern California community health centers.
CRC-HUB-SPOKE:南加州社区健康中心的结肠直肠癌筛查中心。
  • 批准号:
    10689096
  • 财政年份:
    2019
  • 资助金额:
    --
  • 项目类别:
Abnormal Fecal Test Results Associated with Colorectal Cancer Incidence and Mortality
粪便检测结果异常与结直肠癌发病率和死亡率相关
  • 批准号:
    10063801
  • 财政年份:
    2018
  • 资助金额:
    --
  • 项目类别:
Post-polypectomy Surveillance for Reducing Colon Cancer Incidence and Mortality
息肉切除术后监测以降低结肠癌发病率和死亡率
  • 批准号:
    10078600
  • 财政年份:
    2018
  • 资助金额:
    --
  • 项目类别:
Post-polypectomy Surveillance for Reducing Colon Cancer Incidence and Mortality
息肉切除术后监测以降低结肠癌发病率和死亡率
  • 批准号:
    10595066
  • 财政年份:
    2018
  • 资助金额:
    --
  • 项目类别:
Post-polypectomy Surveillance for Reducing Colon Cancer Incidence and Mortality
息肉切除术后监测以降低结肠癌发病率和死亡率
  • 批准号:
    10537988
  • 财政年份:
    2018
  • 资助金额:
    --
  • 项目类别:
Optimizing Colorectal Cancer and Polyp Surveillance after Colorectal Polypectomy
优化结直肠息肉切除术后结直肠癌和息肉监测
  • 批准号:
    8865084
  • 财政年份:
    2015
  • 资助金额:
    --
  • 项目类别:
Optimizing Colorectal Cancer and Polyp Surveillance after Colorectal Polypectomy
优化结直肠息肉切除术后结直肠癌和息肉监测
  • 批准号:
    9145517
  • 财政年份:
    2015
  • 资助金额:
    --
  • 项目类别:
Project 2: A randomized trial of outreach and inreach strategies for boosting colorectal cancer screening in a Federally-Qualified Health Center primarily serving low income Hispanic/Latinos
项目 2:在主要为低收入西班牙裔/拉丁美洲人服务的联邦合格健康中心进行外展和内展策略的随机试验,以促进结直肠癌筛查
  • 批准号:
    9349472
  • 财政年份:
    2008
  • 资助金额:
    --
  • 项目类别:
Outreach Core
外展核心
  • 批准号:
    9349470
  • 财政年份:
    2008
  • 资助金额:
    --
  • 项目类别:

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  • 批准号:
    7353899
  • 财政年份:
    2006
  • 资助金额:
    --
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Toward a Political Theory of Bioethics: Participation, Representation, and Deliberation on Federal Bioethics Advisory Committees
迈向生命伦理学的政治理论:联邦生命伦理学咨询委员会的参与、代表和审议
  • 批准号:
    0451289
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    2005
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  • 批准号:
    7902286
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Advisory Committees
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  • 批准号:
    7691385
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