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

Romaguera D 1 , Ward H 2 , Wark PA 3 , Vergnaud AC 4 , Peeters PH 5 , van Gils CH 6 Show all authors , Ferrari P 7 , Fedirko V 8 , Jenab M 9 , Boutron-Ruault MC 10 , Dossus L 11 , Dartois L 12 , Hansen CP 13 , Dahm CC 14 , Buckland G 15 , Sánchez MJ 16 , Dorronsoro M 17 , Navarro C 18 , Barricarte A 19 , Key TJ 20 , Trichopoulou A 21 , Tsironis C 22 , Lagiou P 23 , Masala G 24 , Pala V 25 , Tumino R 26 , Vineis P 27 , Panico S 28 , Bueno-de-Mesquita HB 29 , Siersema PD 30 , Ohlsson B 31 , Jirström K 32 , Wennberg M 33 , Nilsson LM 34 , Weiderpass E 35 , Kühn T 36 , Katzke V 37 , Khaw KT 38 , Wareham NJ 39 , Tjønneland A 40 , Boeing H 41 , Quirós JR 42 , Gunter MJ 43 , Riboli E 44 , Norat T 45

Affiliations 

  • 1 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. [email protected]
  • 2 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. [email protected]
  • 3 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. [email protected]
  • 4 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. [email protected]
  • 5 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. [email protected]
  • 6 Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500 3508 GA, Utrecht, The Netherlands. [email protected]
  • 7 International Agency for Cancer Research (IARC), 150 Cours Albert Thomas, 69372, Lyon, CEDEX 08, France. [email protected]
  • 8 Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, USA. [email protected]
  • 9 International Agency for Cancer Research (IARC), 150 Cours Albert Thomas, 69372, Lyon, CEDEX 08, France. [email protected]
  • 10 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, 94805, Villejuif, Cedex, France. [email protected]
  • 11 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, 94805, Villejuif, Cedex, France. [email protected]
  • 12 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, 94805, Villejuif, Cedex, France. [email protected]
  • 13 Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark. [email protected]
  • 14 Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark. [email protected]
  • 15 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, 08908, Barcelona, Spain. [email protected]
  • 16 Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Campus Universitario de Cartuja, Cuesta del Observatorio, 4, 18011, Granada, Spain. [email protected]
  • 17 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. [email protected]
  • 18 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. [email protected]
  • 19 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. [email protected]
  • 20 Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK. [email protected]
  • 21 Hellenic Health Foundation, 13 Kaisareias Street, Athens, GR-115 27, Greece. [email protected]
  • 22 Hellenic Health Foundation, 13 Kaisareias Street, Athens, GR-115 27, Greece. [email protected]
  • 23 Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens, GR-115 27, Greece. [email protected]
  • 24 Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Via delle Oblate 4, 50141, Florence, Italy. [email protected]
  • 25 Epidemiology and Prevention Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, Milan, Italy. [email protected]
  • 26 Cancer Registry and Histopathology Unit, "Civic - M.P. Arezzo" Hospital, Via Dante Alighieri 109, I-97100, ASP, Ragusa, Italy. [email protected]
  • 27 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. [email protected]
  • 28 Dipartimento di Medicina Clinica e Chirurgia, Federico II University, VIA PANSINI 5, 80131, Naples, Italy. [email protected]
  • 29 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. [email protected]
  • 30 Department of Gastroenterology and Hepatology, University Medical Centre, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. [email protected]
  • 31 Division of Internal Medicine, Department of Clinical Sciences, Skane University Hospital, Malmo, Lund University, Inga-Maria Nilssons gata 32, 205 02, Lund, Sweden. [email protected]
  • 32 Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Barngatan 2B, SE- 221 85, Lund, Sweden. [email protected]
  • 33 Public Health and Clinical Medicine, Nutritional Research, Umeå University, S-901 87, Umeå, Sweden. [email protected]
  • 34 Arctic Research Centre, Umeå University, S-901 87, Umeå, Sweden. [email protected]
  • 35 Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, ISM - Universitetet i Tromsø, 9037, Tromsø, Norway. [email protected]
  • 36 German Cancer Research Center (DKFZ), Division of Cancer Epidemiology Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany. [email protected]
  • 37 German Cancer Research Center (DKFZ), Division of Cancer Epidemiology Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany. [email protected]
  • 38 University of Cambridge School of Clinical Medicine, Clinical Gerontology Unit Box 251, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK. [email protected]
  • 39 MRC Epidemiology Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK. [email protected]
  • 40 Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark. [email protected]
  • 41 Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, 69120, Germany. [email protected]
  • 42 Public Health Directorate, Ciriaco Miguel Vigil 9, Oviedo, 33417, Asturias, Spain. [email protected]
  • 43 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. [email protected]
  • 44 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. [email protected]
  • 45 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. [email protected]
BMC Med, 2015 May 07;13:107.
PMID: 25948112 DOI: 10.1186/s12916-015-0332-5

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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