Romaguera 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 M, Weiderpass Elisabete, Kühn Tilman, Katzke Verena, Khaw Kay-Tee, Wareham Nick J, Tjønneland Anne, Boeing Heiner, Quirós José R, Gunter Marc J, Riboli Elio, Norat Teresa
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK.
Instituto de Investigación Sanitaria de Palma (IdISPa), Hospital Universitario Son Espases, Research Unit I-1, Ctra. de Valldemossa 79, 07010, Palma de Mallorca, Spain.
BMC Med. 2015 May 7;13:107. doi: 10.1186/s12916-015-0332-5.
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.
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.
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.
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.
癌症幸存者被建议遵循世界癌症研究基金会/美国癌症研究学会（WCRF/AICR）提出的关于饮食、体育活动和身体脂肪的生活方式建议以预防癌症。先前的研究表明，使用指数评分（WCRF/AICR评分）衡量的与这些建议的更高一致性与更低的癌症发病率和死亡率相关。本研究的目的是评估结直肠癌（CRC）患者诊断前与WCRF/AICR建议的一致性与死亡率之间的关联。
在欧洲癌症与营养前瞻性调查（EPIC）队列中，对3292名被诊断为CRC的参与者进行前瞻性研究，评估诊断前平均6.4年时的WCRF/AICR评分（男性评分范围为0 - 6，女性为0 - 7；分数越高表示一致性越高）与CRC特异性死亡率（n = 872）和总死亡率（n = 1113）之间的关联（诊断后平均随访时间为4.2年）。使用多变量Cox比例风险模型估计死亡率的风险比（HRs）和95%置信区间（CIs）。
与建议一致性最低的参与者（评分第1类：0 - 2/0 - 3）相比，评分第二（男性/女性评分范围：2.25 - 2.75/3.25 - 3.75）、第三（3 - 3.75/4 - 4.75）和第四（4 - 6/5 - 7）类别的参与者中，CRC特异性死亡率的HRs（95% CIs）分别为0.87（0.72 - 1.06）、0.74（0.61 - 0.90）和0.70（0.56 - 0.89）（趋势P < 0.0001）。观察到总死亡率的HRs类似（趋势P = 0.004）。在相互调整的模型中，符合身体脂肪和植物性食物消费建议与CRC病例的生存率提高相关。
CRC诊断前与WCRF/AICR关于饮食、体育活动和身体脂肪的建议更高的一致性与CRC患者生存率的提高相关。
