Robinson, Jamaica R.M.

BACKGROUNDBody weight is associated with colorectal cancer (CRC) risk and survival, but to the authors' knowledge, the impact of long‐term postdiagnostic weight change is unclear. Herein, the authors investigated whether weight change over the 5 years after a diagnosis of CRC is associated with survival.METHODSCRC cases diagnosed from 1997 to 2008 were identified through 4 population‐based cancer registry sites. Participants enrolled within 2 years of diagnosis and reported their height and weight 2 years prior. Follow‐up questionnaires were administered approximately 5 years after diagnosis. Associations between change in weight (in kg) or body mass index (BMI) with overall and CRC‐specific survival were estimated using Cox regression analysis adjusted for age, sex, American Joint Committee on Cancer stage of disease, baseline BMI, nonsteroidal anti‐inflammatory drug use, smoking, time between diagnosis and enrollment, and study site.RESULTSAt the 5‐year postdiagnostic survey, 2049 participants reported higher (53%; median plus 5 kg), unchanged (12%), or lower (35%; median ‐4 kg) weight. Over a median of 5.1 years of subsequent follow‐up (range, 0.3‐9.9 years), 344 participants died (91 of CRC). Long‐term weight loss (per 5 kg) was found to be associated with poorer overall survival (hazard ratio, 1.13; 95% confidence interval, 1.07‐1.21) and CRC‐specific survival (hazard ratio, 1.25; 95% confidence interval, 1.13‐1.39). Significantly lower survival was similarly observed for relative weight loss (>5% vs ≤5% change), BMI reduction (per 1 unit), or BMI category change (overweight to normal vs remaining overweight).CONCLUSIONSWeight loss 5 years after a diagnosis of CRC was found to be significantly associated with decreased long‐term survival, suggesting the importance of avoiding weight loss in survivors of CRC. Future research should attempt to further evaluate this association, accounting for whether this weight change was intentional or represents a marker of declining health. Cancer 2017;123:4701‐4708. © 2017 American Cancer Society.

BACKGROUNDAlthough previous studies have noted an increased risk of colorectal cancer (CRC) among moderate to heavy alcohol consumers in comparison with nondrinkers, the relation between alcohol consumption and CRC survival remains unclear.METHODSCases of incident invasive CRC diagnosed between 1997 and 2007 were identified via population‐based cancer registries at 4 study sites in the Colon Cancer Family Registry. Study participants completed a risk‐factor questionnaire on prediagnostic behaviors, including wine, beer, and liquor consumption, at the baseline. Prospective follow‐up for survival was conducted for 4966 CRC cases. Cox regression was used to compare nondrinkers with individuals who consumed, on average, 1 or more servings of alcohol per day in the years preceding their CRC diagnosis with respect to overall and disease‐specific survival. Separate analyses by beverage type, stratified by patient and tumor attributes, were also performed. All models were adjusted for the age at diagnosis, sex, study site, year of diagnosis, smoking history, body mass index, and education.RESULTSPrediagnostic beer and liquor consumption was not associated with CRC survival; however, higher levels of wine consumption were modestly associated with a better prognosis overall (CRC‐specific hazard ratio [HR], 0.70, 95% confidence interval [CI], 0.48‐1.03; overall HR, 0.70; 95% CI, 0.53‐0.94). Similar patterns were noted in stratified analyses.CONCLUSIONSThese findings suggest that prediagnostic wine consumption is modestly associated with more favorable survival after CRC. Cancer 2017;123:1035–43. © 2016 American Cancer Society.

Abstract Previous studies have shown an increased risk of colorectal cancer (CRC) among moderate to heavy alcohol consumers relative to non-drinkers; however, the relationship between alcohol and CRC survival remains unclear. Using data from the international Colon Cancer Family Registry (CCFR), we assessed the association between pre-diagnostic alcohol intake and survival outcomes after CRC diagnosis, overall and stratified by patient and tumor attributes. CRC cases were identified via population-based cancer registries at four CCFR study sites, with diagnoses of incident, invasive CRC from 1997 to 2006. Study participants completed a risk factor questionnaire at enrollment which included information on several pre-diagnostic behaviors, including consumption of wine, beer, and liquor. Prospective follow-up for survival outcomes was conducted for 4858 CRC cases with complete data on alcohol consumption. Using Cox proportional hazards regression models with delayed entry to account for the time between diagnosis and study enrollment, we compared non-drinkers (i.e., alcohol intake <1 drink per week) to individuals who consumed, on average, <1 serving of alcohol per day (but ≥1 per week), and those who consumed ≥1 serving per day in the years preceding CRC diagnosis. Separate analyses were carried out for overall and disease-specific survival. All models were adjusted for age at diagnosis, sex, study site, year of diagnosis, smoking history, CRC screening history, and body mass index. Over a mean follow-up of 7.5 years, 1872 (39%) study participants died, 1110 (59%) of whom died from CRC. Pre-diagnostic beer and liquor consumption were not associated with CRC survival; however, consumption of ≥1 serving of wine per day was modestly associated with more favorable overall [hazard ratio (HR) = 0.80, 95% confidence interval (CI): 0.63-1.00] and disease-specific survival (HR = 0.83, 95% CI: 0.62-1.12). In stratified analyses, having consumed ≥1 serving of wine per day was slightly, but not statistically significantly, more strongly associated with overall survival among men than among women (HR = 0.71 vs. 0.91, respectively, p-heterogeneity = 0.12) and among those aged ≤50 than those aged >50 years (HR = 0.66 vs. 0.84, p-heterogeneity = 0.35). Similar patterns were noted with respect to disease-specific survival. There were no differences in the relationships between wine consumption and survival outcomes stratified by tumor site, microsatellite instability, BRAF-mutation, or CpG island methylator phenotype status. These results suggest that wine consumption prior to CRC diagnosis is modestly associated with more favorable survival after CRC diagnosis. This modest inverse association does not appear to be limited to specific colorectal tumor subtypes and extends beyond overall survival to disease-specific outcomes. Citation Format: Amanda I. Phipps, Jamaica Robinson, Peter T. Campbell, Aung Ko Win, Jane Figueiredo, Noralane M. Lindor, Polly A. Newcomb. Prediagnostic alcohol consumption and colorectal cancer survival: the Colon Cancer Family Registry. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3425.