Integrating clinical data in mechanistic modeling of colorectal cancer evolution in inflammatory bowel disease

BrianJohnson

UC San Diego

"Integrating clinical data in mechanistic modeling of colorectal cancer evolution in inflammatory bowel disease"

Patients with inflammatory bowel disease (IBD) face an elevated risk of colorectal cancer (CRC), necessitating lifelong surveillance to find and remove precancers before they become malignant. Current one-size-fits-all approaches are inadequate and tailored strategies that consider cancer evolution are needed. To address this, we developed a mechanistic framework of IBD-CRC progression. Our multi-type branching process model accounts for IBD onset, mutational processes, and both precancerous (adenoma/dysplasia) and malignant clonal expansion. Initial parameter estimation for mutation and growth rates when fitting the multi-stage clonal expansion model to epidemiological IBD-CRC data yielded similar estimates to those found previously in sporadic CRC but suggest higher mutation rates and slightly lower growth rates in IBD. However, this data may not perfectly represent the natural history, as surveillance colonoscopy with lesion removal and colectomy alter the observable progression. Further, fitting to cancer incidence data alone presents parameter identifiability issues, restricting our initial fit to four parameters. To address these limitations, our study draws upon extensive clinical data from the U.S. Veterans Health Administration, employing validated methods using large language models to construct high-quality datasets with detailed information on surveillance colonoscopy timing, colectomies, and intermediate lesions extracted from pathology reports. To integrate these data, we developed a complementary fast simulation model, which will be released as an R package. This simulation model incorporates clinical interventions, such as colonoscopy with size-dependent lesion removal. Our combined analytical and simulation approach captures the complex precancerous evolution in IBD, providing a quantitative foundation for more effective, personalized surveillance guidelines. Further, this approach can be adapted to improve surveillance in the general population.
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