Optimizing long-term post-polypectomy surveillance for colorectal cancer prevention using a prediction rule developed from a large, community-based cohort

使用基于大型社区队列的预测规则优化长期息肉切除术后监测以预防结直肠癌

• 批准号: 9766215
• 负责人: Jeffrey Kuang Zou Lee
• 金额: $ 17.17万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-14 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9766215
• 关键词: Address; Adenomatous Polyps; Adherence; Age; Award; California; Cancer Etiology; Cessation of life; Chemopreventive Agent; Clinical Investigator; Cohort Analysis; Cohort Studies; Colonoscopy; Colorectal Cancer; Communities; Confounding Factors (Epidemiology); DNA; Data; Development; Development Plans; Electronic Health Record; Epidemiologic Methods; Excision; Frequencies; Funding; Future; Goals; Grant; Guidelines; Health Care Costs; Healthcare Systems; Incidence; Knowledge; Lead; Link; Literature; Longterm Follow-up; Malignant Neoplasms; Medical Informatics; Mentors; Mentorship; Methods; National Cancer Institute; Natural Language Processing; Outcome; Pathology; Patient risk; Patients; Phase; Physicians; Policies; Polypectomy; Polyps; Population; Population Research; Population Study; Premalignant; Prevention; Randomized Controlled Trials; Recommendation; Regimen; Reporting; Research; Research Personnel; Resources; Risk; Risk Factors; Risk stratification; Scheme; Stratification; Surveillance Modeling; Surveillance Program; Testing; Time; Training; United States; United States National Institutes of Health; Unnecessary Procedures; Work; Writing; adenoma; base; career; career development; cohort; colorectal cancer prevention; colorectal cancer risk; colorectal cancer screening; community based participatory research; cost; design; evidence base; follow-up; high risk; improved; mortality; multidisciplinary; population based; predictive modeling; risk prediction model; screening; skills; surveillance strategy; tool

PROJECT SUMMARY AND ABSTRACT The purpose of this K07 proposal is to provide Jeffrey Lee, MD, MAS with the protected time and resources to pursue the additional training needed to reach his long-term goal of becoming an independent clinical investigator, focused on colorectal cancer (CRC) prevention. Screening has been shown to reduce the incidence and mortality for CRC. However, screening has resulted in a growing cohort of patients with adenomatous polyps (adenomas) and little is known about effectively managing their post-polypectomy surveillance. With limited data available in the literature to determine the appropriate timing and frequency of follow-up colonoscopy for patients after adenoma removal, recommendations for post-polypectomy surveillance from our national guidelines have been imprecise at best. For example, the currently recommended range of 5-10 years for a surveillance colonoscopy for patients with a single adenoma covers a two-fold difference in exam frequency, with resultant two-fold impact on patient risk, cost, and colonoscopy capacity. To help optimize the timing of colonoscopic surveillance and guide appropriate utilization of this invasive and costly resource, stratification of CRC risk after colonoscopic polypectomy from a large community-based cohort with long-term follow-up is needed. Building on his prior work in CRC screening, Dr. Lee seeks to fill this knowledge gap by optimizing surveillance practices in post-polypectomy patients according to patient-, polyp-, and colonoscopy exam-related factors. Specifically, he will determine the long- term CRC risk in patients after colonoscopic polypectomy in a very large “real world” community-based population (Aim 1). He will also identify patient-, polyp-, and exam-related risk factors associated with incident CRC in these patients (Aim 2). Finally, he will develop a CRC risk prediction model that will identify post- polypectomy patients at high and low risk for developing subsequent CRC (Aim 3). To achieve these goals, Dr. Lee and his mentors have designed a career development plan for research and educational training to obtain: 1) knowledge and expertise in advanced epidemiologic methods for design and analysis of cohort studies; 2) knowledge in medical informatics methods; and 3) predictive modeling skills. To achieve the proposed research aims, Dr. Lee will leverage the rich electronic health records of Kaiser Permanente Northern California, a large community-based healthcare system, in which data on patient, physician, colonoscopy, pathology, and CRC status have been collected since 1994. In addition, Dr. Lee will use an established natural language processing tool to efficiently collect data and evaluate potential confounding variables from more than 600,000 colonoscopy reports in order to address one of the main practical challenges that have limited the feasibility of large-scale population-based studies. Thus, completion of these aims has the potential to improve prevention and early detection of CRC, impact current surveillance guidelines for post-polypectomy patients, and reduce overuse and underuse of surveillance colonoscopy. Importantly, this proposal is realistic and feasible within the award period and will allow Dr. Lee to continue to build research skills, generate preliminary data, create additional collaborative relationships, and compete for R01 funding. In summary, this K07 award will support and accelerate the career development activities of Dr. Lee and allow him to successfully launch into the next phase of his career as an independent investigator.

项目概要和摘要 此 K07 提案的目的是为 MAS 医学博士 Jeffrey Lee 提供受保护的时间和资源，以 寻求实现成为独立临床医生的长期目标所需的额外培训 研究人员专注于结直肠癌 (CRC) 预防，已被证明可以减少结直肠癌 (CRC) 的发生。 然而，筛查导致结直肠癌患者数量不断增加。 腺瘤性息肉（腺瘤），而对于有效管理息肉切除术后的情况知之甚少 文献中可用的数据有限，无法确定适当的时间和频率。 腺瘤切除后患者的随访结肠镜检查，息肉切除术后的建议 例如，我们国家指南的监测充其量是不精确的。 对单个腺瘤患者进行结肠镜监测的推荐范围为 5-10 年，涵盖 检查频率的两倍差异，对患者风险、费用和结肠镜检查产生两倍的影响 帮助优化结肠镜监测的时间并指导适当利用。 侵入性且昂贵的资源，结肠镜息肉切除术后结直肠癌风险的分层 需要基于社区的队列进行长期随访，以他之前在 CRC 筛查方面的工作为基础。 Lee 试图通过优化息肉切除术后患者的监测实践来填补这一知识空白 具体来说，他会根据患者、息肉和结肠镜检查相关因素来确定长期。 在一个非常大的基于社区的“现实世界”中，结肠镜息肉切除术后患者的足月 CRC 风险 他还将确定与事件相关的患者、息肉和检查相关的风险因素。 最后，他将开发一个 CRC 风险预测模型来识别这些患者的 CRC（目标 2）。 息肉切除术患者发生后续 CRC 的风险较高和较低（目标 3）。 李和他的导师设计了一个研究和教育培训的职业发展计划，以获得： 1) 用于设计和分析队列研究的先进流行病学方法的知识和专业知识；2) 医学信息学方法方面的知识；以及 3) 预测建模技能。 为了研究目标，李博士将利用 Kaiser Permanente Northern 丰富的电子健康记录 加利福尼亚州，一个以社区为基础的大型医疗保健系统，其中包含患者、医生、结肠镜检查、 自 1994 年以来一直在收集病理学和 CRC 状态。此外，Lee 博士将使用已建立的自然方法 语言处理工具，可有效收集数据并评估更多潜在混杂变量 超过 600,000 份结肠镜检查报告，以解决限制性的主要实际挑战之一 因此，完成这些目标有可能实现大规模人群研究的可行性。 改善结直肠癌的预防和早期发现，影响当前息肉切除术后监测指南 重要的是，这一建议是现实的。 并且在奖励期内可行，将使李博士能够继续培养研究技能，产生 初步数据，建立额外的合作关系，并争夺 R01 资金总而言之，这。 K07 奖将支持和加速李博士的职业发展活动，并使他能够 作为一名独立调查员，他成功进入了职业生涯的下一阶段。