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
• 负责人: Samir Gupta
• 金额: $ 50.02万
• 依托单位: VETERANS MEDICAL RESEARCH FDN/SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-02-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10537988
• 关键词: Adherence; Cancer Etiology; Cessation of life; Clinical; Colon Carcinoma; Colonoscopy; Colorectal Cancer; Detection; Effectiveness; Excision; Exposure to; Guidelines; Hemorrhage; Incidence; Individual; Knowledge; Malignant Neoplasms; Measures; Medical Records; Patients; Polypectomy; Polyps; Precancerous Polyp; Research; Risk; Sampling; Time; United States; United States Department of Veterans Affairs; cohort; colorectal cancer risk; cost; design; follow-up; indexing; mortality; neoplasm registry; screening

Modified Project Summary/Abstract Section Colorectal cancer (CRC) is the 2nd leading cause of cancer death in the United States. Research has consistently shown that screening reduces risks for CRC incidence and mortality. Effectiveness of screening has generally been attributed to detection and removal of precancerous polyps and curable cancers. In usual practice, routine follow up for many patients with polyps removed at baseline includes repeat surveillance colonoscopy to detect and resect additional polyps and cancer. However, the incremental benefit of surveillance colonoscopy over baseline colonoscopy with polyp removal is unclear. Indeed, prior research has not focused on effectiveness of surveillance and has not specifically determined whether a clinical strategy of systematic surveillance after baseline polypectomy reduces the risk of developing or dying from colorectal cancer, compared to no surveillance. Despite this gap in knowledge, current guidelines recommend routine surveillance colonoscopy for the majority of patients with polyps. Since colonoscopy is a burden on patients, associated with risks such as bleeding, and costly, it is imperative to establish whether surveillance reduces CRC risk. Our Specific Aims are to determine whether post polypectomy surveillance colonoscopy reduces CRC incidence (Aim 1) and mortality (Aim 2). To accomplish these aims, we will utilize a previously established cohort of over 400,000 individuals who had colonoscopy with polyp removal within the Department of Veterans Affairs (VA). Using a case-cohort design, all individuals with incident CRC identified by the VA Central Cancer Registry, all individuals with fatal CRC identified by the National Death Index, as well as a random sample of those who had polyps removed at baseline will be selected for study inclusion. We will use medical record review to determine exposure to surveillance colonoscopy and measure other factors that may influence CRC risk. Observed occurrence and timing of surveillance colonoscopy delivered will be summarized using a time-dependent exposure variable that characterizes adherence to post-polypectomy surveillance guidelines. CRC incidence, as well as CRC mortality will be compared among individuals exposed versus unexposed to surveillance colonoscopy, taking into account other factors that may influence CRC risk.

修改后的项目摘要/摘要部分 结直肠癌（CRC）是美国癌症死亡的第二大原因。研究一致表明，筛查可降低结直肠癌发病率和死亡率的风险。筛查的有效性通常归因于癌前息肉和可治愈癌症的检测和切除。在通常的实践中，许多在基线时切除息肉的患者的常规随访包括重复监测结肠镜检查，以检测和切除额外的息肉和癌症。然而，监测结肠镜检查相对于基线结肠镜检查和息肉切除的增量益处尚不清楚。事实上，先前的研究并没有关注监测的有效性，也没有具体确定与不进行监测相比，基线息肉切除术后系统监测的临床策略是否可以降低患结直肠癌或死亡的风险。尽管存在知识差距，目前的指南建议对大多数息肉患者进行常规监测结肠镜检查。由于结肠镜检查对患者来说是一种负担，与出血等风险相关，而且费用昂贵，因此必须确定监测是否可以降低结直肠癌风险。我们的具体目标是确定息肉切除术后监测结肠镜检查是否可以降低 CRC 发病率（目标 1）和死亡率（目标 2）。为了实现这些目标，我们将利用之前在退伍军人事务部 (VA) 内建立的超过 400,000 名接受过结肠镜检查并切除息肉的人的队列。使用病例队列设计，将选择由退伍军人管理局中央癌症登记处识别出的所有患有偶发性结直肠癌的个体、由国家死亡指数识别出的所有患有致命性结直肠癌的个体，以及基线时已切除息肉的随机样本。研究包容性。我们将利用病历审查来确定接受结肠镜监测的情况，并衡量可能影响 CRC 风险的其他因素。观察到的结肠镜检查的发生和时间将使用时间依赖性暴露变量进行总结，该变量表征对息肉切除术后监测指南的遵守情况。将比较暴露与未暴露于监测结肠镜检查的个体的 CRC 发病率和 CRC 死亡率，同时考虑可能影响 CRC 风险的其他因素。