Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: a cohort study

BMC Medicine

Teresa Norat^2,29  Elio Riboli^2,29  Marc J Gunter^2,29  José R Quirós^2,20  Heiner Boeing^1,13  Anne Tjønneland^2,23  Nick J Wareham^1,18  Kay-Tee Khaw^2,27  Verena Katzke^1,15  Tilman Kühn^1,15  Elisabete Weiderpass^2,28  Lena M Nilsson^1,10  Maria Wennberg^1,14  Karin Jirström^1,11  Bodil Ohlsson²  Peter D Siersema^2,26  H Bas Bueno-de-Mesquita^2,24  Salvatore Panico^2,25  Paolo Vineis⁸  Rosario Tumino¹  Valeria Pala^3,31  Giovanna Masala^1,12  Pagona Lagiou^3,30  Christos Tsironis^3,32  Antonia Trichopoulou⁷  Timothy J Key^2,21  Aurelio Barricarte³  Carmen Navarro^1,19  Miren Dorronsoro⁵  María José Sánchez^3,33  Genevieve Buckland^2,22  Christina Catherine Dahm^3,35  Camilla Plambeck Hansen^3,35  Laureen Dartois^1,16  Laure Dossus^1,16  Marie-Christine Boutron-Ruault^1,16  Mazda Jenab⁴  Veronika Fedirko⁶  Pietro Ferrari⁴  Carla H van Gils⁹  Petra H Peeters⁹  Anne-Claire Vergnaud^2,29  Petra A Wark^1,17  Heather Ward^2,29  Dora Romaguera^3,34 

[1] Cancer Registry and Histopathology Unit, “Civic – M.P. Arezzo” Hospital, Via Dante Alighieri 109, I-97100, ASP, Ragusa, Italy;Division of Internal Medicine, Department of Clinical Sciences, Skane University Hospital, Malmo, Lund University, Inga-Maria Nilssons gata 32, Lund, 205 02, Sweden;Navarre Public Health Institute, C/ Leyre, Pamplona, 15 31003, Spain;International Agency for Cancer Research (IARC), 150 Cours Albert Thomas, Lyon CEDEX 08, France;Public Health Direction and Biodonostia Basque Regional Health Department, Avenida Navarra 4, San Sebastian, 20013, Spain;Winship Cancer Institute, Emory University, 1518 Clifton Rd, Atlanta 30322, GA, USA;Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens GR-115 27, Greece;HuGeF Foundation, via Nizza 52, Turin, Italy;Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands;Arctic Research Centre, Umeå University, Umeå, S-901 87, Sweden;Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Barngatan 2B, Lund, SE- 221 85, Sweden;Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Via delle Oblate 4, Florence, 50141, Italy;Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal 69120, Germany;Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, S-901 87, Sweden;German Cancer Research Center (DKFZ), Division of Cancer Epidemiology Im Neuenheimer Feld 581, Heidelberg, D-69120, Germany;Inserm (Institut National de la Santé et de la Recherche Médicale), Centre for Research in Epidemiology and Population Health (CESP), U1018, Team 9, 114 rue Édouard Vaillant, Villejuif, 94805, Cedex, France;Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK;MRC Epidemiology Unit, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK;Department of Health and Social Sciences, Universidad de Murcia, Campus Universitario de Espinardo, s/n, 30100 Espinardo, Murcia, Spain;Public Health Directorate, Ciriaco Miguel Vigil 9, Oviedo 33417, Asturias, Spain;Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK;Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Avda. de la Granvia de l’Hospitalet, 199-203, Barcelona, 08908, Spain;Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen, 2100, Denmark;Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, 50603, Malaysia;Dipartimento di Medicina Clinica e Chirurgia, Federico II University, VIA PANSINI 5, Naples, 80131, Italy;Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, 3508 GA, The Netherlands;University of Cambridge School of Clinical Medicine, Clinical Gerontology Unit Box 251, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK;Department of Genetic Epidemiology, Folkhälsan Research Center, Folkhälsan Research Center, Biomedicum 1, Haartmansgatan 8, PB 63 (B336b), FI-00014 University of Helsinki, Helsinki, Finland;Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary’s Campus, Norfolk Place, London, W2 1PG, UK;Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston 02115, MA, USA;Epidemiology and Prevention Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, Milan, Italy;Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece;CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain;CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain;Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, DK-8000, Denmark

关键词: Weight;    Survival;    Physical activity;    Healthy lifestyle;    Diet;    Colorectal cancer;   

Others  :  1179026
DOI  :  10.1186/s12916-015-0332-5

 received in 2014-12-10, accepted in 2015-03-20,  发布年份 2015

【 摘 要 】

Background

Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients.

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.

【 授权许可】

   
2015 Romaguera et al.; licensee BioMed Central.

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