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
• 负责人: Samir Gupta
• 金额: $ 52.49万
• 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 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10078600
• 关键词: Address; Adenomatous Polyps; Adherence; Advanced Malignant Neoplasm; Advisory Committees; Age; Cancer Etiology; Cessation of life; Characteristics; Clinical; Clinical Trials; Cohort Studies; Colon Carcinoma; Colonoscopy; Colorectal Cancer; Detection; Effectiveness; Ensure; Excision; Exposure to; Guideline Adherence; Guidelines; Hemorrhage; Incidence; Incidence Study; Individual; Intervention; Investments; Knowledge; Malignant Neoplasms; Manuals; Measures; Medical Records; Neoplasms; Observational Study; Outcome; Patients; Perforation; Policies; Polypectomy; Polyps; Precancerous Polyp; Prevention strategy; Public Health; Reporting; Research; Risk; Risk Reduction; Sampling; Societies; Testing; Time; United States; United States Department of Veterans Affairs; Veterans; abstracting; adenoma; base; cancer prevention; cohort; colorectal cancer risk; colorectal cancer screening; comorbidity; cost; design; follow-up; indexing; mortality; neoplasm registry; novel strategies; premalignant; randomized trial; screening; study population; surveillance strategy; uptake

PROJECT SUMMARY 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.

项目摘要 结直肠癌（CRC）是美国癌症死亡的第二大原因。研究有 一贯表明，筛查会降低CRC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去除。通常 练习，许多在基线时去除息肉患者的常规随访包括重复监视 结肠镜检查以检测和分辨其他息肉和癌症。但是，增量的好处 尚不清楚基线结肠镜检查对基线结肠镜检查的监测结肠镜检查尚不清楚。确实，先前的研究已经 不专注于监视的有效性，也没有明确确定是否是一种临床策略 基线多型切除术后的系统监测降低了结直肠的发展或死亡的风险 癌症，而没有监测。尽管知识差距存在差距，但当前的准则建议例行 大多数息肉患者的监测结肠镜检查。由于结肠镜检查是患者的负担，因此 与出血和昂贵的风险相关，必须确定监视是否降低 CRC风险。我们的具体目的是确定多型切除术后结肠镜检查是否会减少 CRC发病率（AIM 1）和死亡率（AIM 2）。为了实现这些目标，我们将利用先前建立的 在退伍军人部门内有超过40万人进行结肠镜检查和息肉去除的人群 事务（VA）。使用Case-Ohort设计，所有患有VA Central Cancer识别的入射CRC的人 注册表，所有由国家死亡指数确定的致命CRC的人，以及随机样本 那些在基线上去除息肉的人将被选中进行研究。我们将使用病历 审查以确定暴露于监视结肠镜检查并测量可能影响CRC的其他因素 风险。观察到的监测结肠镜检查的发生和时间将使用时间概括 依赖性暴露变量，其特征是遵守植物后切除术指南的依从性。 CRC 在暴露与未暴露的个体中，将比较发病率以及CRC死亡率 监视结肠镜检查，考虑到可能影响CRC风险的其他因素。