Individually Tailored Strategies for the Precision Prevention of Gastric Cancer and Colorectal Cancer in the Community
Gastric cancer is a global health threat. Helicobacter pylori is now recognized as the main risk factor that initiates this process; hence, H. pylori eradication has been considered the most effective method to ameliorate the burden of gastric cancer. Serum pepsinogen levels reveal the current atrophy of the stomach and predict gastric cancer risk. A risk prediction model with the combination of H. pylori infection and serum pepsinogen level could identify the highest-risk gastric cancer patients.
Colorectal cancers (CRC) rank second and third as the leading causes of cancer-related death in men and women, respectively. For CRC prevention, a two-stage approach using the fecal immunochemical test (FIT) is popular; besides, the FIT levels may serve as a guide for priority setting in prompting residents to undergo colonoscopy. Therefore, the effectiveness and utility of aggressive referral confirmatory diagnosis protocol in a colorectal cancer screening program for those with high FIT levels urgently need to evaluate.
研究概览
详细说明
Gastric cancer is a global health threat and contributes to more than 720,000 deaths per year. In the absence of early detection, gastric cancer is associated with a high fatality rate-the 5-year survival rate for patients with locally advanced disease is only about 40% despite aggressive treatment. Carcinogenesis in gastric cancer follows a multistage process (i.e., Correa's model) that develops from chronic active gastritis to atrophic gastritis, intestinal metaplasia, dysplasia, and finally to carcinoma. Helicobacter pylori is now recognized as the main risk factor that initiates this process. An estimated 89% of non-cardiac cancers can be prevented if H. pylori can be eradicated from the population of interest; hence, H. pylori eradication has been considered the most effective method to ameliorate the burden of gastric cancer. However, in the setting of mass screening, irreversible damage may already have occurred after patients have harbored H. pylori infection for decades before they undergo screening and treatment for H. pylori. This observation has been supported by a recent meta-analysis based on 8 randomized controlled trials and 16 cohort studies that investigated the magnitude of the benefit from eradication therapy; on average, only a 50% reduction of gastric cancer risk was shown. Altered levels of serum pepsinogens, which are mainly produced by the chief cells of the fundic glands of the stomach, reflect the atrophic status (ie, gland loss) of gastric mucosa. Serum pepsinogen levels not only reveal the past infection status or current atrophy of the stomach, respectively, but have also been shown to be predictive of gastric cancer risk. Therefore, to completely eliminate the burden of gastric cancer, physicians urgently need a risk prediction model with the combination of H. pylori infection and serum pepsinogen level to identify the highest-risk patients for endoscopic examination in the context of limited resources.
Colorectal cancers (CRC) rank second and third as the leading causes of cancer-related death in men and women, respectively, in the world. To reduce the burden of CRC, colonoscopy is the most effective method and can reduce the risk of new-onset CRCs by the removal of adenomatous polyps and can improve CRC survival by the detection of pre-symptomatic malignancies. In addition to primary screening colonoscopy, a two-stage approach using the fecal immunochemical test (FIT) is increasingly popular because of its ability to identify patients with the highest risk of CRC; in this manner, limited colonoscopist resources can be efficiently allocated. Although colonoscopy is associated with a statistically significant reduction in mortality rates for CRC through the detection of early-stage cancers, the FIT levels may serve as a guide for priority setting in prompting residents to undergo colonoscopy. Besides, the prevalence of any CRC and advanced-stage CRC is associated with delays in follow-up colonoscopies for patients with positive results from a FIT. Therefore, the effectiveness and utility of aggressive referral confirmatory diagnosis protocol in a colorectal cancer screening program for those with high FIT levels urgently need to evaluate.
研究类型
注册 (预期的)
联系人和位置
学习地点
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Taipei、台湾
- National Taiwan University Hospital
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
取样方法
研究人群
描述
Inclusion Criteria:
- Aged 50-75 years
- Confirmed non-gastric cancer/colorectal cancer healthy participant
- Mentally competent to be able to understand the consent form
- Able to communicate with study staff for individuals
- Agree to link the screening data to National Cancer Registry
Exclusion Criteria:
- Confirmed gastric cancer/colorectal cancer healthy participant
- Status post gastrectomy
学习计划
研究是如何设计的?
设计细节
队列和干预
团体/队列 |
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Gastric cancer prevention
This prospective study consists of 40,000 participants; after randomization, each arm has 20,000 participants.
Arm 1: participants receive H. pylori stool antigen test; Arm 2: participants receive the combination of H. pylori stool antigen test and serum pepsinogen test.
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Colorectal cancer prevention
This prospective study consists of 40,000 participants; after randomization; each arm has 20,000 participants.
Arm 1: participants with positive fecal immunochemical test (FIT) receive routine referral confirmatory diagnosis approach; Arm 2: participants with positive FIT receive routine referral confirmatory diagnosis approach and participants with high FIT results receive additional aggressive referral confirmatory diagnosis approach.
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
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Gastric cancer prevention
大体时间:Up to 10 years, the gastric cancer incidence per 100,000 person-years is calculated by the person-years of follow-up.
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To assess the combination of H. pylori stool antigen test and serum pepsinogen test as a joint predictor of gastric cancer risk
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Up to 10 years, the gastric cancer incidence per 100,000 person-years is calculated by the person-years of follow-up.
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Colorectal cancer prevention
大体时间:Up to 10 years, the colorectal cancer incidence per 100,000 person-years is calculated by the person-years of follow-up.
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To assess the effectiveness/utility of aggressive referral confirmatory diagnosis protocol in a colorectal cancer screening program
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Up to 10 years, the colorectal cancer incidence per 100,000 person-years is calculated by the person-years of follow-up.
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合作者和调查者
调查人员
- 首席研究员:TSUNG-HSIEN CHIANG, MD, MSc、National Taiwan University Hospital
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (预期的)
研究完成 (预期的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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