Faculty Bibliography

BACKGROUND & AIMS/OBJECTIVE:This study assessed the economic and health impact of colorectal cancer (CRC) screening programs for average-risk individuals aged 45 years and older. METHODS:A 10-year Markov model simulated disease progression, comparing multitarget stool RNA test (mt-sRNA, ColoSense), two mt-sDNA tests (Cologuard and Cologuard Plus), a blood-based test (cfDNA, Shield), and a fecal immunochemical test (FIT). Clinical inputs leveraged age-weighted sensitivity and specificity from independent studies. Outcomes were compared with a colonoscopy-based program and no screening. Model calibration and validation used previously reported Cancer Intervention Surveillance Modeling Network (CISNET) models. RESULTS:Among molecular tests, mt-sRNA detected the most advanced adenomas, referred the most individuals to surveillance, and prevented the highest number of CRC cases and deaths. At real-world adherence of 60%, mt-sRNA reduced CRC cases and deaths by 1% and 14% compared with FIT; by 21% and 19% compared with mt-sDNA; by 28% and 23% compared with mt-sDNA+; and by 80% and 86% compared with cfDNA. For all adherence levels, FIT ($25/test) was the most cost-effective strategy. For triennial molecular tests ($509/test), mt-sRNA was the most cost-effective strategy. Relative to the mt-sRNA program, the cost to prevent a CRC case was 30% (mt-sDNA), 45% (mt-sDNA+), and 642% (cfDNA) more expensive. Relative to the mt-sRNA program, the cost to prevent a CRC death was 30% (mt-sDNA), 41% (mt-sDNA+), and 1040% (cfDNA) more expensive. CONCLUSIONS:FIT was the most cost-effective strategy for preventing CRC cases and deaths. At real-world adherence of 60%, mt-sRNA demonstrated the greatest clinical benefit and was more cost-effective than other molecular strategies.

BACKGROUND/UNASSIGNED:Metastatic colorectal cancer (mCRC) remains a leading cause of cancer-related mortality, emphasizing the need for effective later-line therapies. Fruquintinib, a selective vascular endothelial growth factor receptor (VEGFR)1-3 inhibitor, has emerged as a promising option for refractory mCRC. This systematic review and meta-analysis evaluates its efficacy and safety, both as monotherapy and in combination with programmed death-1 (PD-1) inhibitors. METHODS/UNASSIGNED:Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted across PubMed, Embase, Online Vendor of International Databases (OVID), Cochrane Library, and ClinicalTrials.gov (2010-2025). Included studies were randomized controlled trials (RCTs) or real-world data on fruquintinib in mCRC after at least two prior therapies. Real-world evidence was included to complement RCT findings, as it captures broader populations, treatment patterns, and outcomes not fully reflected in controlled trial settings. Primary outcomes were progression-free survival (PFS) and overall survival (OS); secondary outcomes included objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (AEs). Pooled hazard ratios (HRs) and event rates were calculated using a random-effects model. RESULTS/UNASSIGNED:. 4.0%, P=0.04). In cross-study comparisons, monotherapy appeared to yield numerically longer PFS, although this was not based on head-to-head trials. AEs occurred in 86.7%, with grade ≥3 in 30.9%, most often hypertension (8.1%) and hand-foot skin reaction (5.8%). High heterogeneity was observed for several outcomes including AEs and DCR. CONCLUSIONS/UNASSIGNED:Fruquintinib significantly improves PFS and disease control in refractory mCRC with manageable toxicity. Limitations include heterogeneity across studies, with most conducted in predominantly Chinese cohorts. Further studies should explore optimal combination strategies and biomarker-based selection.

INTRODUCTION/BACKGROUND:Patients with primary sclerosing cholangitis (PSC) and concomitant inflammatory bowel disease (IBD) are at increased risk of colorectal cancer (CRC). However, the risk of CRC in patients with PSC without IBD remains uncertain. We aimed to evaluate the risk of CRC in patients with PSC without a history of IBD using a large national database. METHODS:We conducted a retrospective cohort study using the TriNetX database to identify patients ≥ 18 years with PSC. Patients were then divided into two groups, PSC with IBD (PSC-IBD cohort) and PSC without IBD (PSC non-IBD cohort), and were matched with patients without a history of PSC or IBD (non-PSC/non-IBD group) by using 1:1 propensity score matching. The primary outcome was the risk of first diagnosis of CRC. With censoring applied, Kaplan-Meier analysis with hazard ratios (HRs) and 95% CIs was used to compare time-to-event rates at daily time intervals. RESULTS:PSC patients without IBD were at increased risk of CRC compared to the non-PSC/IBD cohort (aHR = 2.91; 95% CI: 1.6-6.0). Patients with PSC and IBD exhibited a higher risk of CRC (aHR = 6.5; 95% CI: 3.78-11.2), especially among the UC cohort (aHR = 6.3; 95% CI: 3.2-12.4). Patients with PSC were at increased risk of various gastrointestinal malignancies (aHR = 10.5; 95% CI: 7.3-15; p < 0.0001), including hepatobiliary cancers, pancreatic cancer, and hepatocellular carcinoma. DISCUSSION/CONCLUSIONS:Our findings provide real-world evidence that PSC is an independent risk factor for colorectal cancer, even in the absence of concomitant IBD. These results support the need for further research to determine whether patients with isolated PSC may benefit from tailored CRC surveillance strategies.

BACKGROUND:Colorectal cancer (CRC) is the fourth most common and second deadliest cancer in the US. Screening is effective at reducing CRC incidence and mortality, but rates of screening remain suboptimal. There are no sensitive machine learning models for accurately identifying individuals at risk for colorectal cancer or precancerous polyps. OBJECTIVES/OBJECTIVE:The aim of our study was to develop and validate a novel machine learning model that uses multimodal Electronic Health Record (EHR) data, including the most recent complete blood count (CBC), basic metabolic panel (BMP), ICD codes, and medications, to estimate a patient's likelihood of having CRC or an advanced precancerous lesion. METHODS:We developed ColAI, an L1-regularized logistic regression model trained on 1-year trailing EHR data, to predict CRC or advanced adenoma at screening colonoscopy. Labs are treated as continuous variables, while ICD codes and medications are represented as binary indicators of presence. ColAI was trained using 87,825 screening colonoscopies and validated using 21,957 independent colonoscopies between August 1, 2020, and March 31, 2024, from the NYU Langone Health system. RESULTS:ColAI achieved an AUROC of 0.93 for CRC and 0.98 for CRC or advanced adenoma. Performance remained consistent across different hospitals and time periods within NYU Langone, demonstrating strong generalizability. Performance also remained consistent between first and follow-up colonoscopies, decreasing concern for selection bias. CONCLUSIONS:ColAI accurately identifies patients at elevated risk for CRC using only routine EHR data. It has the potential to enhance targeted outreach to high-risk, unscreened individuals and improve early cancer detection at the population level.

INTRODUCTION/BACKGROUND:Colorectal cancer (CRC) screening rates among patients receiving care at multiple federally qualified health care centers (FQHCs) in New York city are low. Proactive outreach through mailed fecal immunochemical tests (FIT), reminders and navigation are evidence based interventions to improve CRC screening rates but remain untested in this study population. OBJECTIVE:To evaluate the effectiveness, implementation, and cost-effectiveness of a multilevel proactive outreach strategy to improve CRC screening rates among underserved adults in Brooklyn, New York. METHODS:This is a randomized controlled trial across five FQHCs serving predominantly Black and low-income populations. Adults aged 45-75 who are overdue for CRC screening are randomized to usual care or a multi-level proactive intervention. The intervention includes mailed education and FIT kits, patient navigation, and support for colonoscopy scheduling and follow-up. The primary outcome is CRC screening completion (FIT or colonoscopy) within six months. Secondary outcomes include colonoscopy follow-up after a positive FIT, implementation barriers and facilitators, and cost-effectiveness. RESULTS:A total of 1379 participants have been enrolled through May 2025. DISCUSSION/CONCLUSIONS:This trial addresses a critical gap in CRC prevention by testing a scalable, multilevel outreach model tailored to underserved populations. Findings will inform future strategies to enhance screening rates while reducing screening disparities through sustainable FQHC-based programs.

BACKGROUND:Given COVID-19's emergence as a new entity and colorectal cancer's (CRC) rising incidence in certain populations, we conducted this retrospective cohort study to determine the link between COVID-19 and the mortality of those with CRC and how socioeconomic factors influence it. METHODS:Using the National Cancer Database (NCDB), we used logistic regression to get the odds ratio (OR) for delayed treatment and Cox proportional hazards modeling for each stage to get the adjusted hazard ratios (HR) of mortality. RESULTS:COVID-19 positivity was associated with higher mortality and delayed treatment. The association of race, ethnicity, insurance, urbanization, comorbidity burden, education levels, and income varied by when the patient tested positive relative to colorectal cancer diagnosis. CONCLUSIONS:This implies that vaccinations may be a part of management and that CRC patients who develop COVID-19 infection may warrant closer follow-up during treatment.

This study evaluated the effectiveness of large language models (LLMs) and vision-language models (VLMs) in gastroenterology. We used board-style multiple-choice questions to assess the performance of both proprietary and open-source LLMs and VLMs-including GPT, Claude, Gemini, Mistral, Llama, Mixtral, Phi, and Qwen, across different interfaces, computing environments, and levels of compression (quantization). Among the proprietary models, o1-preview (82.0%) and Claude3.5-Sonnet (74.0%) had the highest accuracy, outperforming the top open-source models: Llama3.3-70b (65.7%) and Qwen-2.5-72b (61.0%). Among the small quantized open-source models, the 8-bit Llama 3.2-11b (51.7%) and 6-bit Phi3-14b (48.7%) performed the best, with scores comparable to their full-precision counterparts. Notably, VLM accuracy on image-containing questions improved (~10%) when given human-generated captions, remained unchanged with original images, and declined with LLM-generated captions. Further research is warranted to evaluate model capabilities in real-world clinical decision-making scenarios.

BACKGROUND:Infliximab (IFX) is commonly used in the management of acute severe ulcerative colitis (ASUC), yet up to 30% of individuals still require colectomy within 1 year. Clinical data characterizing these patients, however, are limited. AIMS/OBJECTIVE:We aimed to determine risk factors for colectomy among patients with ASUC who received in-hospital IFX treatment. METHODS:We performed a retrospective analysis of patients with ASUC who were treated with at least one dose of IFX while admitted between 2014 and 2022. Cox proportional hazards (PH) models were used to assess demographic, clinical, and laboratory risk factors for colectomy within 30 days and 1 year of IFX initiation. RESULTS:Overall, 36/170 (21.2%) patients underwent colectomy within 1 year of IFX initiation, with 22 (12.9%) individuals requiring colectomy within 30 days. On univariable analysis, concomitant Clostridioides difficile infection during admission, a ≤50% decrease in C-reactive protein (CRP) and experiencing 3 or more bowel movements per day within 48 hours after an initial IFX dose were significantly associated with 1-year colectomy. On multivariable Cox PH analysis, C. difficile infection during admission (aHR=2.92, 95% CI: 1.12-7.58) and a higher CRP/albumin ratio on admission (aHR=1.13, 95% CI: 1.01-1.27) were associated with increased colectomy risk within 1 year of IFX initiation. CONCLUSIONS:C. difficile infection and a higher CRP/albumin ratio on admission are associated with decreased time to colectomy within 1 year of IFX among patients presenting with ASUC. These factors may aid in early risk stratification to minimize delays in JAK-inhibitor initiation or surgical referral.