Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: A cohort study
AuthorRomaguera, Dora; Ward, Heather; Wark, Petra A.; Vergnaud, Anne-Claire; Peeters, Petra H.; van Gils, Carla H.; Ferrari, Pietro; Fedirko, Veronika; Jenab, Mazda; Boutron-Ruault, Marie-Christine; Dossus, Laure; Dartois, Laureen; Hansen, Camilla Plambeck; Dahm, Christina Catherine; Buckland, Genevieve; Sánchez, María-José; Dorronsoro, Miren; Navarro, Carmen; Barricarte, Aurelio; Key, Timothy J.; Trichopoulou, Antonia; Tsironis, Christos; Lagiou, Pagona; Masala, Giovanna; Pala, Valeria; Tumino, Rosario; Vineis, Paolo; Panico, Salvatore; Bueno-de-Mesquita, H. Bas; Siersema, Peter D.; Ohlsson, Bodil; Jirström, Karin; Wennberg, Maria; Nilsson, Lena Maria; Weiderpass, Elisabete; Kühn, Tilman; Katzke, Verena A.; Khaw, Kay-Tee; Wareham, Nicholas J.; Tjønneland, Anne; Boeing, Heiner; Quirós, José Ramón; Gunter, Mark J.; Riboli, Eilo; Norat, Teresa
Methods: The association between the WCRF/AICR score (score range 0–6 in men and 0–7 in women; higher scores indicate greater concordance) assessed on average 6.4 years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2 years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality.
Results: The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/ women: 2.25–2.75/3.25–3.75), third (3–3.75/4–4.75), and fourth (4–6/5–7) categories of the score were 0.87 (0.72–1.06), 0.74 (0.61–0.90), and 0.70 (0.56–0.89), respectively (P for trend <0.0001), compared to participants with the lowest concordance with the recommendations (category 1 of the score: 0–2/0–3). Similar HRs for overall mortality were observed (P for trend 0.004). Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models.
Conclusions: Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.