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.

项目概要 结直肠癌（CRC）是美国癌症死亡的第二大原因。研究有 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。平时 实践中，对许多在基线时切除息肉的患者进行常规随访包括重复监测 结肠镜检查以发现并切除额外的息肉和癌症。然而，增量效益 监测结肠镜检查与息肉切除基线结肠镜检查的比较尚不清楚。事实上，之前的研究已经 没有关注监测的有效性，也没有具体确定是否有临床策略 基线息肉切除术后的系统监测可降低结直肠癌发生或死亡的风险 与没有监测相比，癌症。尽管存在知识差距，但当前的指南建议常规 对大多数息肉患者进行监测结肠镜检查。由于肠镜检查对患者来说是一种负担， 由于与出血等风险相关且成本高昂，因此必须确定监测是否会减少 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会减少 CRC 发病率（目标 1）和死亡率（目标 2）。为了实现这些目标，我们将利用先前建立的 退伍军人部内超过 400,000 名接受结肠镜检查并切除息肉的人组成的队列 事务（弗吉尼亚州）。采用病例队列设计，由 VA Central Cancer 识别出所有患有 CRC 事件的个体 登记处、国家死亡指数确定的所有患有致命性结直肠癌的个人以及随机样本 那些在基线时切除息肉的人将被选择纳入研究。我们将使用医疗记录 进行审查以确定是否接受结肠镜监测并测量可能影响 CRC 的其他因素 风险。观察到的结肠镜检查的发生和时间将使用时间总结 依赖暴露变量，表征对息肉切除术后监测指南的遵守情况。 CRC 将比较接触过和未接触过的个体的发病率和结直肠癌死亡率 监测结肠镜检查，考虑可能影响结直肠癌风险的其他因素。