Gastric Cancer Prevention: Evaluating U.S. Risk Factor Trends and New Technology

描述（由申请人提供）：本研究的目标是确定有效的胃癌预防方案，以改善美国的癌症结局，减少差异，并提高胃癌预防的成本效益。这将通过构建一个灵活的胃癌决策分析模拟模型来实现，该模型能够估计风险因素模式对胃癌趋势的贡献，并评估成本，收益，初级（戒烟）和二级（监测）预防策略的成本效益。由于一些因素正在改变胃癌控制的格局，包括对疾病自然史的更好理解，危险因素在疾病进展中的作用，以及新的无创内镜技术来检测和治疗癌前病变和癌性病变，该模型将综合现有的临床、流行病学和经济数据，以预测长期结果并指导临床研究设计。我们的具体目标是：(1)建立胃癌的自然历史模型，包括危险因素在疾病进展中的作用。该模型将使用美国年龄特异性患病率和癌前病变和癌症发病率的流行病学数据进行经验校准；(2)估计幽门螺杆菌、吸烟等危险因素患病率下降对胃癌发病率下降的影响。使用基于人群的胃癌模型，我们将纳入危险因素趋势数据来预测胃癌发病率和死亡率；(3)评估基于技术的癌前病变监测和治疗策略的成本效益。我们将评估内镜和基于血清学的诊断和治疗技术对发育不良和无症状癌症病变的有效性；(4)比较不同胃癌控制策略的相对疗效。我们将开发特定种族/民族、移民和其他精选亚群的自然历史模型，纳入人口趋势，并评估预防和治疗策略对改善癌症预后和减少差异的影响。总之，本研究将综合现有的最佳数据，改进现有的建模框架，并开发一套新的分析工具来估计和预测胃癌的趋势；建立胃癌前病变患者的管理指南；并提供与不同胃癌防治策略相关的相对成本、收益和风险。我的职业目标是成为一名独立的研究者，致力于应用多学科、决策分析方法来改善癌症预防和控制政策。与辅助数据分析、高级决策分析方法和流行病学方面的额外培训相结合，在多学科和高度协作的环境中执行这项拟议的指导研究将提供成功过渡到研究独立所需的额外经验、知识和技能。

DESCRIPTION (provided by applicant): The goal of the proposed research is to identify effective gastric cancer prevention programs that improve cancer outcomes, reduce disparities, and enhance the cost-effectiveness of gastric cancer prevention in the U.S. This will be accomplished by constructing a flexible decision-analytic simulation model of gastric cancer capable of estimating the contribution of risk factor patterns on gastric cancer trends and assessing the costs, benefits, and cost-effectiveness of primary (smoking cessation) and secondary (surveillance) prevention strategies. As several factors are changing the landscape of gastric cancer control, including a better understanding of the disease natural history, role of risk factors on disease progression, and new noninvasive endoscopic technology to detect and treat precancerous and cancerous lesions, this model will synthesize available clinical, epidemiologic, and economic data to project long-term outcomes and guide clinical study design. Our specific aims are: (1) to develop a natural history model of gastric cancer, including the role of risk factors on disease progression. This model will be empirically calibrated using U.S. epidemiologic data on age-specific prevalence and incidence of precancerous lesions and cancer; (2) to estimate the decline in gastric cancer incidence attributable to declining prevalence of H. pylori, smoking, and other risk factors. Using a population-based model of gastric cancer we will incorporate data on risk factor trends to forecast gastric cancer incidence and mortality; (3) to assess the cost-effectiveness of technology-based surveillance and treatment strategies for patients with precancerous lesions. We will evaluate the effectiveness of endoscopic and serology-based diagnostic and therapeutic technologies for dysplastic and asymptomatic cancerous lesions; (4) to compare the relative effectiveness of alternative gastric cancer control strategies on disparities. We will develop natural history models for specific race/ethnicity, immigrant, and other select subgroups, incorporate demographic trends, and assess the impact of prevention and treatment strategies to improve cancer outcomes and reduce disparities. In summary, this research will synthesize the best available data, improve upon an existing modeling framework, and develop a new set of analytic tools to estimate and project gastric cancer trends; establish management guidelines for patients with gastric precancerous lesions; and provide insight on the relative costs, benefits, and risks associated with different gastric cancer prevention and control strategies. My career goal is to become an independent investigator dedicated to the application of multidisciplinary, decision- analytic methods to improve cancer prevention and control policies. In conjunction with additional training in secondary data analysis, advanced decision-analytic methods, and epidemiology, the execution of this proposed mentored research in a multidisciplinary and highly-collaborative environment will provide the additional experience, knowledge, and skills needed to successfully transition to research independence.