Controlling Esophageal Cancer: A Collaborative Modeling Approach

 描述(申请人提供)：控制食道癌：一种协作建模方法。拟议研究项目的最终目标是促进我们对食道癌的了解，以及癌症控制干预措施的影响，以减轻这种疾病的负担。这将通过一个合作和比较的建模项目来实现。食道癌有两种主要的组织学类型：腺癌(EAC)和鳞癌(ESCC)。尽管ESCC在全球范围内更常见，但在美国和西方世界的大部分地区，EAC更常见，也更令人担忧。食管腺癌(EAC)的发病率在过去的几十年里经历了显著的增长(超过6倍)，这在很大程度上是无法解释的。到目前为止，初步筛查和预防工作主要针对有胃食道反流病(GERD)症状的患者，使用内窥镜和活检来识别Barrett‘s食道(BE)患者，并将BE患者作为内窥镜监测的目标。没有确凿的证据表明这种筛查/监测策略是有效的，这一点突出表现在存活率持续低下，而很大一部分癌症继续在晚期和浸润性阶段被诊断出来。据估计，美国有4000-6000万GERD患者和300万-1200万BE患者，对EAC风险显著增加的患者的管理已成为一个重要的公共卫生问题。除了不确定的长期益处外，目前未经证实的策略可能会使患者遭受过度测试和过度诊断，在花费大量医疗资源的同时，对患者的生活质量产生负面影响。研究小组之前的工作包括通过三个独立的模型对EAC的自然历史进行比较建模，为执行评估和改进筛查和预防策略的分析提供了坚实的基础：具体地说，评估新的筛查技术、预防、基因组和其他生物标记物以及临床预测工具等尖端增强技术。精确的风险分层是目标，更广泛的目标是确定一种有效的癌症控制策略，同时限制过度检测和过度治疗，从而减轻患者负担并提高医疗效率。这些建模工作将提供构建决策辅助所需的个性化患者数据，通过将管理选择与个人筛查偏好相结合，将患者筛查负担降至最低。最后，虽然该项目最初的重点将是东非共同体，但在全球范围内，尤其是在中国等亚洲部分地区，ESCC更为常见和广泛。这些模型将扩展到包括ESCC自然历史部分，并评估美国和中国的ESCC筛查。该提案将解决主要目标，即增加我们对食道癌自然历史的了解，并确定影响和潜在的癌症控制干预措施，最终目标是改善癌症发病率。

 DESCRIPTION (provided by applicant): Controlling Esophageal Cancer: A Collaborative Modeling Approach. The ultimate goal of the proposed research project is to advance our understanding of esophageal cancer and the impact of cancer control interventions to diminish the burden of this disease. This will be accomplished through a collaborative and comparative modeling project. There are two main histologic types of esophageal cancer: adenocarcinoma (EAC) and Squamous Cell Carcinoma (ESCC). Although ESCC is more common globally, in the US and much of the western world, EAC is more common and of greater concern. Esophageal AdenoCarcinoma (EAC) has experienced a remarkable (more than 6-fold) increase in incidence over the past few decades, which is largely unexplained. To date, primary screening and prevention efforts have targeted patients with symptoms of gastroesophageal reflux disease (GERD) using endoscopy and biopsy to identify patients with Barrett's esophagus (BE), with BE patients targeted for endoscopic surveillance. There is no firm evidence indicating that this screening/surveillance strategy is effective, which is underscored by persistently poor survival rates while a large proportion of cancers continue to be diagnosed at late and invasive stages. With an estimated 40-60 million Americans with GERD and 3-12 million with BE, the management of patients who are at significantly increased risk of EAC has become an important public health issue. In addition to uncertain long-term benefits, current unproven strategies may subject patients to overtesting and overdiagnosis, negatively impacting patient quality of life while expending considerable medical resources. The research team's prior work includes comparative modeling of the natural history of EAC by three independent models providing a strong foundation upon which to perform analyses that assess and improve screening and prevention strategies: specifically, the evaluation of cutting-edge enhancements such as new screening technologies, prevention, genomic and other biomarkers, and clinical prediction tools. Precision risk stratification is the aim, with the broader goal to identify a caner control strategy that is effective while limiting overtesting and overtreatment, thereby reducing patient burden and improving healthcare efficiency. These modeling efforts will provide the personalized patient data necessary to construct a decision aid, which will minimize patient screening burden by aligning management choices with personal preferences for screening. Finally, although the initial focus of the project will be on EAC, ESCC is more common and widespread globally, particularly in parts of Asia such as China. The models will be extended to include an ESCC natural history component and assess ESCC screening in the US and China. The proposal will address the overarching goals of increasing our understanding of the natural history of esophageal cancer and determining the impact and of potential cancer control interventions with the ultimate goal of ameliorating cancer morbidity.