Optimizing Colorectal Cancer and Polyp Surveillance after Colorectal Polypectomy

优化结直肠息肉切除术后结直肠癌和息肉监测

• 批准号: 10011577
• 负责人: Samir Gupta
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2019-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10011577
• 关键词: Adenomatous Polyps; Advisory Committees; Age; Algorithms; Area; Aspirin; Budgets; Calibration; Cancer Etiology; Caring; Cessation of life; Characteristics; Clinical; Clinical Data; Colon; Colonoscopy; Colorectal; Colorectal Cancer; Colorectal Neoplasms; Colorectal Polyp; Data; Data Element; Data Set; Detection; Diet; Discrimination; Disease; Documentation; Dysplasia; Effectiveness; Ensure; Excision; Family; Feedback; Fees; Frequencies; Gastroenterology; Goals; Growth; Guidelines; Health; Healthcare; Histology; Human Subject Research; Hyperplastic Polyp; Individual; Informatics; Infrastructure; Intervention; Intestines; Investments; Label; Leadership; Location; Manuals; Measures; Medical; Medical Records; Methods; Minority; Modeling; Monitor; National Comprehensive Cancer Network; National Health Interview Survey; Natural Language Processing; Neoplasms; Outcome; Outcomes Research; Pathologic; Pathology; Patients; Performance; Pharmaceutical Preparations; Polypectomy; Polyps; Population; Preparation; Prevention; Provider; Publications; Recommendation; Recording of previous events; Records; Recurrence; Reporting; Research; Research Infrastructure; Research Personnel; Resources; Risk; Risk Assessment; Risk Factors; Risk stratification; Sampling; Science; Sensitivity and Specificity; Site; Smoking; Specificity; Techniques; Testing; Text; Therapeutic; Training; United States; Validation; Veterans; Villous; Visual; Woman; Work; adenoma; base; cancer diagnosis; cancer prevention; cancer risk; clinical practice; clinically relevant; cohort; colon cancer prevention; colon cancer screening; colorectal cancer prevention; colorectal cancer risk; colorectal cancer screening; computerized; data warehouse; experience; follow-up; high risk; human subject protection; impression; improved; innovation; interest; novel; personalized strategies; predictive modeling; primary endpoint; primary outcome; red meat consumption; response; risk prediction model; screening; sex

 DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the 2nd leading cause of cancer death nationally, and the 3rd most commonly diagnosed cancer among Veterans. To reduce cancer risk, small growths in the colon called polyps found at colonoscopy are routinely removed. Current guidelines recommend repeat colonoscopy in 3, 5, or 10 years based on select features of polyps removed. However, the current approach is not accurate for cancer risk prediction. Late colonoscopy (in 5 or 10 years) is often recommended for individuals who go on to develop cancer or high-risk polyps. Conversely, early colonoscopy (in 3 years) is often recommended for individuals who go on to develop only low-risk findings. The result is suboptimal cancer prevention. The overall goal of this project is to develop a new, more personalized and comprehensive strategy for assessing risk for new polyps and CRC after initial polyp removal, including patient factors (such as age), baseline polyp factors (such as number, size, location), and quality factors (such as average polyp detection rate of the doctor performing colonoscopy). To develop the strategy, national VA colonoscopy and medical record data will be accessed to identify Veterans who have had polyp removal and at least one follow up colonoscopy between 1999 and 2012. At least 30,000 Veterans are expected to meet these criteria. Next, computerized Natural Language Processing (NLP) techniques will be developed to extract risk and outcome data of interest from colonoscopy and pathology records. These innovative techniques are required because the most valuable information available for risk prediction is only available in "free text" format witin these clinical reports. The alternative approach to data extraction (manual review of each Veteran's medical chart) is impractical, and indeed it is for this reason that research in this are has previously not been possible on a large-scale. Application of these NLP techniques will allow creation of a large, representative dataset of all Veterans who have had colonoscopy with polyp removal. In the third part of this research, a statistical risk stratification strategy to prdict risk for polyps and CRC after initial polyp removal will be developed using this dataset. Performance of the new strategy will be compared to current guidelines for predicting risk for CRC and high-risk polyps after initial polyp removal. The project is significant because Veterans are at high risk for CRC, but strategies for managing cancer risk are suboptimal. The project is innovative because we will apply cutting edge NLP methods to make use of data that is representative of all Veterans who have had polyp removal within the VA, and develop risk prediction models that go beyond current guidelines by using more personalized risk measures. The research team's expertise and significant prior work specific to CRC and polyps, and the rigorous approach proposed, ensure that the project is feasible and will be successful. Ultimately, investment in this Merit Review has great potential to improve CRC prevention for Veterans, and beyond. CRITIQUE 1 1. Significance. NCCN guidelines take into account age (>50) and family history and only recommends a 10 year interval for patients without a FH and with no polyp identified or if hyperplastic polyps are identified. For patients with an adenomatous polyp removed the recommendation varies between 3 years and 5 years based on polyp number, size, and histology (villous or presence of high grade dysplasia). The assertion that colonoscopy is suboptimal for cancer prevention is in part true but primarily due to access issues and compliance with screening and less so due to surveillance intervals . The idea of a personalized interval is already in place and while a little more difficult in the veteran population, providers still make their recommendations based on individual factors in concert with national guidelines. Efforts to develop a computerized entry form to quantify and record needed information seem more important. 2. Approach It is unclear if Aim 1 will use path records to only evaluate adenomatous polyps and if so the recommendations only differ by 2 years. Accepting a low detection rate from a provider/site and/or using that as a risk factor to increase screening frequency seems like a "work around" and more direct quality interventions to monitor and raise detection rates seem more valuable. The primary endpoint consists of polyp size, polyp number and histology. The discrepancy between endoscopic visual size and pathologic size needs to worked out 3. Impact and Innovation. Given that the utilization of colon cancer screening is only around 50% nationally (2005 National Health Interview Survey) and with documented capacity issues at some VAs who have limited screening colonoscopy (fee basis) and prioritized therapeutic colonoscopy. Any study findings calling for increased screening may be unfulfilled. This study will evaluate veterans who have had at least two colonoscopies. 4. Investigator Qualifications, and Facilities and Resources. This is an experienced team. 5. Multiple PI Leadership Plan. N/A 6. Adequacy of Response to Previous Feedback Provided by HSR&D Regarding the Proposed Study. 7. Protection of Human Subjects from Research Risk. Adequate 8. Inclusion of Women and Minorities in Research. Adequate 9. Budget. Adequate 10. Overall Impression. 11. Key Strengths. 1. Colon cancer prevention is an important area. 2. Good collaborative team with extensive experience 12. Key Weaknesses. 1. This seems like a validation of NLP in a large cohort 2. Information on preventative medications such as aspirin or other dietary risks factors such as red meat consumption and BMI are not addressed

 描述（由申请人提供）： 结直肠癌 (CRC) 是全国癌症死亡的第二大原因，也是退伍军人中第三大最常见的癌症。为了降低癌症风险，结肠镜检查中发现的结肠中称为息肉的小生长物通常会被切除，目前的指南建议定期进行结肠镜检查。根据切除的息肉的特定特征，3、5 或 10 年。然而，目前的方法对于癌症风险预测并不准确，通常建议继续接受结肠镜检查的个体进行晚期结肠镜检查（5 或 10 年）。如果发现癌症或高风险息肉，通常会建议那些仅发现低风险结果的人进行早期结肠镜检查。该项目的总体目标是开发一种预防癌症的方法。新的、更个性化和全面的策略，用于评估初次息肉切除后新发息肉和结直肠癌的风险，包括患者因素（如年龄）、基线息肉因素（如数量、大小、位置）和质量因素（如平均息肉）医生表现的检出率为了制定该策略，将访问国家 VA 结肠镜检查和医疗记录数据，以确定 1999 年至 2012 年间接受过息肉切除术并至少进行过一次结肠镜检查的退伍军人。预计至少有 30,000 名退伍军人符合这些标准。将开发计算机自然语言处理（NLP）技术，以从结肠镜检查和病理记录中提取感兴趣的风险和结果数据，因为只有可用于风险预测的最有价值的信息是可用的。在这些临床报告中以“自由文本”格式提取数据的替代方法（手动审查每个退伍军人的医疗图表）是不切实际的，事实上，正是由于这个原因，这方面的研究以前不可能进行大规模的研究。这些 NLP 技术的应用将允许创建所有接受过息肉切除结肠镜检查的退伍军人的大型代表性数据集。在本研究的第三部分中，我们将采用统计风险分层策略来预测初始息肉后发生息肉和结直肠癌的风险。移除意愿将使用该数据集来开发新策略的性能，并将其与当前预测息肉切除后的结直肠癌和高风险息肉风险的指南进行比较。该项目具有创新性，因为我们将应用最先进的 NLP 方法来利用代表退伍军人管理局内所有接受过息肉切除术的退伍军人的数据，并通过使用更个性化的方法来开发超越当前指南的风险预测模型。风险措施。团队的专业知识和针对 CRC 和息肉的重要前期工作，以及所提出的严格方法，确保了该项目的可行性并最终取得成功，对本次绩效评估的投资具有改善退伍军人及其他人群的 CRC 预防的巨大潜力。 1 1.意义。 NCCN 指南考虑了年龄（> 50 岁）和家族史，仅建议没有 FH 且未发现息肉的患者间隔 10 年，或者对于已切除腺瘤性息肉的患者，建议间隔 3 年。根据息肉数量、大小和组织学（绒毛或存在高度不典型增生），结肠镜检查对于预防癌症不是最佳方案的说法部分正确，但主要是由于访问问题。以及对筛查的依从性，而由于监测间隔而较少依从性 个性化间隔的想法已经到位，尽管还有些不足。 对于退伍军人来说，这更加困难，但提供者仍然根据个人因素并结合国家指导方针提出建议，努力开发计算机化的登记表来量化和记录所需的信息似乎更为重要。 2. 方法 目前尚不清楚目标 1 是否会使用路径记录仅评估腺瘤性息肉，如果是的话，建议仅相差 2 年。 接受提供商/站点的低检出率和/或将其用作增加筛查频率的风险因素似乎是一种“变通办法”，并且更直接的质量干预措施来监测和提高检出率似乎更有价值。 主要终点包括息肉大小、息肉数量和组织学。需要计算内窥镜视觉大小和病理大小之间的差异。 3.影响和创新。 鉴于全国范围内结肠癌筛查的利用率仅为 50% 左右（2005 年全国健康访谈调查），并且记录了一些 VA 的能力问题，这些机构的筛查结肠镜检查（收费）和优先治疗性结肠镜检查有任何研究结果要求增​​加筛查。这项研究将评估至少接受过两次结肠镜检查的退伍军人。 4. 研究者资格、设施和资源。 这是一支经验丰富的团队。 5. 多个 PI 领导计划。 不适用 6. 对 HSR&D 先前提供的有关拟议研究的反馈的充分回应。 7. 保护人类受试者免受研究风险。 充分 8. 将妇女和少数群体纳入研究。 足够的 9.预算。 足够 10. 总体印象 11. 主要优势。 1.结肠癌的预防是一个重要领域。 2. 良好的协作团队，经验丰富 12. 主要弱点。 1. 这似乎是 NLP 在大型队列中的验证 2. 未提及阿司匹林等预防药物或红肉消费和体重指数等其他饮食风险因素的信息

项目成果

Racial and Ethnic Disparities in Colorectal Cancer Screening Pose Persistent Challenges to Health Equity.

结直肠癌筛查中的种族和民族差异对健康公平构成持续挑战。

• 发表时间: 2020
• 作者: Demb, Joshua;Gupta, Samir
• 通讯作者: Gupta, Samir

Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer.

结肠镜检查和息肉切除术后的随访建议：美国结直肠癌多社会工作组的共识更新。

• 发表时间: 2020
• 影响因子: 7.7
• 作者: Gupta, Samir;Lieberman, David;Anderson, Joseph C;Burke, Carol A;Dominitz, Jason A;Kaltenbach, Tonya;Robertson, Douglas J;Shaukat, Aasma;Syngal, Sapna;Rex, Douglas K
• 通讯作者: Rex, Douglas K

Baseline Characteristics and Longitudinal Outcomes of Traditional Serrated Adenomas: A Cohort Study.

传统锯齿状腺瘤的基线特征和纵向结果：一项队列研究。

• 发表时间: 2023-06
• 作者: Trivedi, Mehul;Godil, Suha;Demb, Joshua;Earles, Ashley;Bustamante, Ranier;Patterson, Olga V;Gawron, Andrew J;Kaltenbach, Tonya;Mahata, Sumana;Liu, Lin;Gupta, Samir
• 通讯作者: Gupta, Samir

A Nationwide Survey and Needs Assessment of Colonoscopy Quality Assurance Programs in the VA.

退伍军人管理局结肠镜检查质量保证计划的全国调查和需求评估。

• 发表时间: 2018-03
• 作者: Gawron, Andrew J;Lawrence, Phillip;Millar, Morgan M;Dominitz, Jason A;Gupta, Samir;Whooley, Mary;Kaltenbach, Tonya
• 通讯作者: Kaltenbach, Tonya

Does Colon Polyp Surveillance Improve Patient Outcomes?

结肠息肉监测能否改善患者的治疗效果？

• 发表时间: 2020
• 影响因子: 29.4
• 作者: Lieberman, David;Gupta, Samir
• 通讯作者: Gupta, Samir