Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
J Clin Oncol. 2022 Mar 1;40(7):740-751. doi: 10.1200/JCO.21.01784. Epub 2022 Jan 7.
Current tools in predicting survival outcomes for patients with colon cancer predominantly rely on clinical and pathologic characteristics, but increasing evidence suggests that diet and lifestyle habits are associated with patient outcomes and should be considered to enhance model accuracy.
Using an adjuvant chemotherapy trial for stage III colon cancer (CALGB 89803), we developed prediction models of disease-free survival (DFS) and overall survival by additionally incorporating self-reported nine diet and lifestyle factors. Both models were assessed by multivariable Cox proportional hazards regression and externally validated using another trial for stage III colon cancer (CALGB/SWOG 80702), and visual nomograms of prediction models were constructed accordingly. We also proposed three hypothetical scenarios for patients with (1) good-risk, (2) average-risk, and (3) poor-risk clinical and pathologic features, and estimated their predictive survival by considering clinical and pathologic features with or without adding self-reported diet and lifestyle factors.
Among 1,024 patients (median age 60.0 years, 43.8% female), we observed 394 DFS events and 311 deaths after median follow-up of 7.3 years. Adding self-reported diet and lifestyle factors to clinical and pathologic characteristics meaningfully improved performance of prediction models (c-index from 0.64 [95% CI, 0.62 to 0.67] to 0.69 [95% CI, 0.67 to 0.72] for DFS, and from 0.67 [95% CI, 0.64 to 0.70] to 0.71 [95% CI, 0.69 to 0.75] for overall survival). External validation also indicated good performance of discrimination and calibration. Adding most self-reported favorable diet and lifestyle exposures to multivariate modeling improved 5-year DFS of all patients and by 6.3% for good-risk, 21.4% for average-risk, and 42.6% for poor-risk clinical and pathologic features.
Diet and lifestyle factors further inform current recurrence and survival prediction models for patients with stage III colon cancer.
目前预测结肠癌患者生存结果的工具主要依赖于临床和病理特征，但越来越多的证据表明，饮食和生活方式习惯与患者的预后相关，应将其纳入模型以提高准确性。
我们使用 III 期结肠癌（CALGB 89803）辅助化疗试验的数据，通过纳入自我报告的 9 种饮食和生活方式因素，建立无病生存（DFS）和总生存的预测模型。两个模型均通过多变量 Cox 比例风险回归进行评估，并使用另一个 III 期结肠癌（CALGB/SWOG 80702）试验进行外部验证，相应地构建了预测模型的视觉诺模图。我们还为（1）低危、（2）中危和（3）高危的临床病理特征的患者提出了三种假设情况，并通过考虑是否纳入自我报告的饮食和生活方式因素，来估计他们的预测生存情况。
在 1024 例患者（中位年龄 60.0 岁，43.8%为女性）中，中位随访 7.3 年后，观察到 394 例 DFS 事件和 311 例死亡。将自我报告的饮食和生活方式因素纳入临床和病理特征显著提高了预测模型的性能（DFS 的 C 指数从 0.64（95%CI，0.62 至 0.67）提高到 0.69（95%CI，0.67 至 0.72），总生存的 C 指数从 0.67（95%CI，0.64 至 0.70）提高到 0.71（95%CI，0.69 至 0.75））。外部验证也表明了区分度和校准度的良好表现。将大多数自我报告的有利饮食和生活方式暴露纳入多变量建模中，提高了所有患者的 5 年 DFS，低危患者提高了 6.3%，中危患者提高了 21.4%，高危患者提高了 42.6%。
饮食和生活方式因素进一步为 III 期结肠癌患者的复发和生存预测模型提供了信息。
