Tailored Screening for Urinary System Cancers in Patients with Chronic Kidney Disease

慢性肾病患者泌尿系统癌症的定制筛查

基本信息

批准号：
10654677
负责人：
Stella Kang
金额：
$ 50.58万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10654677
关键词：
Accounting Address Adherence Adult Affect Aftercare Age Anatomy Bladder Calibration Cancer Burden Cardiovascular Diseases Cardiovascular system Caring Cause of Death Cessation of life Chronic Kidney Failure Classification Clinical Cohort Studies Colorectal Cancer Complex Computer Simulation Data Set Detection Diagnosis Epidemiology Evaluation Event Frequencies General Population Goals Guidelines Health Health Status Hypertension Incidence Internal Medicine K-Series Research Career Programs Kidney Kidney Neoplasms Life Expectancy Link Magnetic Resonance Imaging Malignant Neoplasms Malignant neoplasm of lung Malignant neoplasm of ureter Malignant neoplasm of urinary bladder Modeling Monitor Morbidity - disease rate Natural History Nephrology Obesity Outcome Pathway interactions Patient advocacy Patients Perception Persons Population Population Heterogeneity Practice Guidelines Prevention strategy Primary Care Proteinuria Public Health Publishing Quality of life Quality-Adjusted Life Years Radiology Specialty Recommendation Recurrence Renal Cell Carcinoma Renal Mass Renal carcinoma Renal function Risk Risk Factors Science Screening for cancer Severities Severity of illness Smoking Subgroup Testing Translating Urinary system Urinary tract Urologic Cancer Urologic Oncology Urology Urothelium Work aged black men black women cancer risk cardiovascular risk factor clinical practice comorbidity cost cost effective cost effectiveness cost estimate experience hazard human old age (65+)improved middle age models and simulation mortality mortality risk patient subsets screening screening guidelines ultrasound urinary young man

项目摘要

Project Summary Chronic kidney disease (CKD) is a highly prevalent condition, found in 20% of people aged 50 years and older. While it is well known that CKD is strongly associated with cardiovascular mortality, recent work has demonstrated an association with cancer risk that also merits consideration for preventive strategies. Cancer is the leading cause of death in mid-life patients afflicted by early stages of CKD, and the 2nd leading cause across all CKD patients under 65 years. Specifically, kidney cancers occur three times more often in patients with CKD, including a hazard ratio of up to 3.4 in younger men (40-52 years) with moderate CKD (15-60 mL/min/1.73 m2). Indeed, the incidence of kidney cancer in mid-life patients with CKD is similar to that of colorectal cancer in the general population. Risks of bladder cancer are similarly increased in CKD. Current guidelines recommend that CKD patients undergo monitoring of common renal and cardiovascular risk factors that overlap with those of urinary tract cancers such as smoking, hypertension, and obesity. Thus, the lack of clear cancer screening recommendations represents an important gap in CKD practice guidelines, and may be due to the complex weighing of benefits and harms for a population with wide-ranging health status. Our team of experts in decision science, epidemiology, urologic oncology, nephrology, radiology, and internal medicine will apply complementary experience to assess the potential of screening strategies. We previously developed and published a computer simulation model of kidney tumors and comorbidities, supported by an NCI K award, the Renal Anatomy and Function for Renal Masses (Re-AFFiRM) simulation model. Our model is capable of simulating outcomes of subpopulations defined by CKD severity and kidney tumor natural history. We will transform the model to incorporate bladder cancer natural history as well as kidney and bladder screening pathways. We will assess whether cancer screening pathways benefit life expectancy and quality-adjusted life expectancy based on age, CKD stage, strong co-existing risk factors, and comorbidity burden. Middle-aged adults without other significant cardiovascular comorbidity and multiple established risk factors may warrant more intensive screening, whereas patients with cardiovascular disease and few risk factors may warrant less intensive screening. In addition, Black men and women with CKD have been shown repeatedly to suffer higher all-cause and cancer-specific mortality compared to non-Black CKD patients, an important consideration in forming screening recommendations. Our findings will be evaluated by a group of independent stakeholders in primary care, nephrology, urology, and patient advocacy to consider the acceptability and barriers to screening as supported by the model results. Cost-effectiveness will also be explored for key factors that affect or elevate the value of screening. Our goal will be to establish the context in which urinary tract screening recommendations could benefit the large population with CKD.

项目概要慢性肾脏病 (CKD) 是一种非常普遍的疾病，20% 的 50 岁及年纪大了。虽然众所周知 CKD 与心血管死亡率密切相关，但最近的研究表明证明与癌症风险相关，也值得考虑预防策略。癌症是早期 CKD 中年患者死亡的主要原因，也是第二大原因涵盖 65 岁以下的所有 CKD 患者。具体来说，肾癌患者的发病率是其三倍患有 CKD，其中患有中度 CKD（15-60 岁）的年轻男性（40-52 岁）的风险比高达 3.4 毫升/分钟/1.73 平方米）。事实上，中年 CKD 患者的肾癌发病率与正常人相似。普通人群中的结直肠癌。 CKD 患者患膀胱癌的风险也同样增加。当前的指南建议 CKD 患者接受常见肾脏和心血管危险因素的监测与吸烟、高血压和肥胖等尿路癌症重叠。因此，缺乏明确的癌症筛查建议代表了 CKD 实践指南中的一个重要差距，并且可能是由于对健康状况各异的人群的利益和危害进行了复杂的权衡。我们的专家团队由决策科学、流行病学、泌尿肿瘤学、肾病学、放射学和内科将运用补充经验来评估筛查策略的潜力。我们之前开发并发布了肾脏肿瘤和合并症的计算机模拟模型，肾脏肿块的肾脏解剖和功能 (Re-AFFiRM) 模拟得到 NCI K 奖的支持模型。我们的模型能够模拟由 CKD 严重程度和肾脏定义的亚群的结果肿瘤自然史。我们将改造模型以纳入膀胱癌自然史以及肾脏和膀胱筛查途径。我们将评估癌症筛查途径是否有益于生活基于年龄、CKD 阶段、强烈共存风险因素的预期寿命和质量调整预期寿命，以及合并症负担。没有其他显着心血管合并症且患有多种疾病的中年人已确定的危险因素可能需要更深入的筛查，而患有心血管疾病的患者很少有风险因素可能需要较少的密集筛查。此外，患有 CKD 的黑人男性和女性多次被证明与非黑人 CKD 相比，其全因死亡率和癌症特异性死亡率更高患者，这是形成筛查建议的重要考虑因素。我们的研究结果将由以下人员评估初级保健、肾脏病学、泌尿科和患者倡导领域的一组独立利益相关者需要考虑模型结果支持的筛查可接受性和障碍。性价比也会探索影响或提升筛查价值的关键因素。我们的目标是建立背景哪些尿路筛查建议可以使大量 CKD 患者受益。