Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
Am J Clin Nutr. 2021 Jun 1;113(6):1447-1457. doi: 10.1093/ajcn/nqaa394.
An unhealthy lifestyle is associated with the risk of colorectal cancer (CRC), but it is unclear whether overall lifestyle after a CRC diagnosis is associated with risks of recurrence and mortality.
To examine associations between postdiagnosis lifestyle and changes in lifestyle after a CRC diagnosis with risks of CRC recurrence and all-cause mortality.
The study population included 1425 newly diagnosed, stage I-III CRC patients from 2 prospective cohort studies enrolled between 2010 and 2016. Lifestyle, including BMI, physical activity, diet, and alcohol intake, was assessed at diagnosis and at 6 months postdiagnosis. We assigned lifestyle scores based on concordance with 2 sets of cancer prevention guidelines-from the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and the American Cancer Society (ACS)-and national disease prevention guidelines. Higher scores indicate healthier lifestyles. We computed adjusted HRs and 95% CIs using Cox regression.
We observed 164 recurrences during a 2.8-year median follow-up and 171 deaths during a 4.4-year median follow-up. No associations were observed for CRC recurrence. A lifestyle more consistent with the ACS recommendations was associated with a lower all-cause mortality risk (HR per +1 SD, 0.85; 95% CI: 0.73-0.995). The same tendency was observed for higher WCRF/AICR (HR, 0.92; 95% CI: 0.78-1.08) and national (HR, 0.90; 95% CI: 0.77-1.05) lifestyle scores, although these associations were statistically nonsignificant. Generally, no statistically significant associations were observed for BMI, physical activity, diet, or alcohol. Improving one's lifestyle after diagnosis (+1 SD) was associated with a lower all-cause mortality risk for the ACS (HR, 0.80; 95% CI: 0.67-0.96) and national (HR, 0.84; 95% CI: 0.70-0.999) scores, yet was statistically nonsignificant for the WCRF/AICR score (HR, 0.94; 95% CI: 0.78-1.13).
A healthy lifestyle after CRC diagnosis and improvements therein were not associated with the risk of CRC recurrence, but were associated with a decreased all-cause mortality risk.
不健康的生活方式与结直肠癌（CRC）的风险相关，但尚不清楚 CRC 诊断后的整体生活方式是否与复发和死亡风险相关。
研究 CRC 诊断后生活方式与生活方式改变与 CRC 复发和全因死亡率的关系。
该研究人群包括 2010 年至 2016 年期间纳入的 2 项前瞻性队列研究中的 1425 例新诊断的 I-III 期 CRC 患者。在诊断时和诊断后 6 个月评估生活方式，包括 BMI、体力活动、饮食和饮酒。我们根据与世界癌症研究基金会/美国癌症研究所（WCRF/AICR）和美国癌症协会（ACS）的 2 套癌症预防指南以及国家疾病预防指南的一致性，对生活方式评分进行了赋值。分数越高表示生活方式越健康。我们使用 Cox 回归计算了调整后的 HR 和 95%CI。
在 2.8 年的中位随访期间观察到 164 例复发，在 4.4 年的中位随访期间观察到 171 例死亡。CRC 复发与生活方式无关联。与 ACS 建议更一致的生活方式与全因死亡率降低相关（每增加 1 个 SD 的 HR，0.85；95%CI：0.73-0.995）。同样的趋势也出现在更高的 WCRF/AICR（HR，0.92；95%CI：0.78-1.08）和国家（HR，0.90；95%CI：0.77-1.05）生活方式评分中，尽管这些关联没有统计学意义。一般来说，BMI、体力活动、饮食或饮酒与统计学无显著关联。诊断后改善生活方式（增加 1 个 SD）与 ACS（HR，0.80；95%CI：0.67-0.96）和国家（HR，0.84；95%CI：0.70-0.999）评分的全因死亡率降低相关，但 WCRF/AICR 评分无统计学意义（HR，0.94；95%CI：0.78-1.13）。
CRC 诊断后健康的生活方式及其改善与 CRC 复发风险无关，但与全因死亡率降低相关。
