TY - JOUR
T1 - Diet- and Lifestyle-Based Prediction Models to Estimate Cancer Recurrence and Death in Patients With Stage III Colon Cancer (CALGB 89803/Alliance)
AU - Cheng, En
AU - Ou, Fang Shu
AU - Ma, Chao
AU - Spiegelman, Donna
AU - Zhang, Sui
AU - Zhou, Xin
AU - Bainter, Tiffany M.
AU - Saltz, Leonard B.
AU - Niedzwiecki, Donna
AU - Mayer, Robert J.
AU - Whittom, Renaud
AU - Hantel, Alexander
AU - Al Benson, Benson
AU - Atienza, Daniel
AU - Messino, Michael
AU - Kindler, Hedy
AU - Giovannucci, Edward L.
AU - Van Blarigan, Erin L.
AU - Brown, Justin C.
AU - Ng, Kimmie
AU - Gross, Cary P.
AU - Meyerhardt, Jeffrey A.
AU - Fuchs, Charles S.
N1 - Funding Information:
Supported by the NCI of NIH under award numbers U10CA180821 and U10CA180882 (to the Alliance for Clinical Trials in Oncology; F.-S.O.), UG1CA233290 (to L.B.S.), U10CA180863 CCTG (to R.W.), U10CA180820 ECOG-ACRIN (to A.B.B.), UG1CA233180 (to J.A.M. and R.J.M.), UG1CA233327, UG1CA233337, UG1CA189858, U10CA180888 SWOG (to A.H.), K07CA197077 (to E.L.V.B.), R01CA118553 (to C.S.F. and F.-S.O.), and R01CA205406 (to K.N.). CALGB 89803 clinical trial was supported in part by funds from Pharmacia & Upjohn Company (now Pfizer Oncology; https:// acknowledgments.alliancefound.org). K.N. was supported in part by Department of Defense grant CA160344 and the Project P Fund. J.A.M. was supported by the Douglas Gray Woodruff Chair Fund, the Guo Shu Shi Fund, Anonymous Family Fund for Innovations in Colorectal Cancer, Project P Fund, and the George Stone Family Foundation. C.S.F. was supported in part by a Stand Up To Cancer Colorectal Cancer Dream Team Translational Research Grant (SU2C-AACR-DT22-17). Research grants are administered by the American Association for Cancer Research, the Scientific Partner of SU2C.
Funding Information:
Supported by the NCI of NIH under award numbers U10CA180821 and U10CA180882 (to the Alliance for Clinical Trials in Oncology; F.-S.O.), UG1CA233290 (to L.B.S.), U10CA180863 CCTG (to R.W.), U10CA180820 ECOG-ACRIN (to A.B.B.), UG1CA233180 (to J.A.M. and R.J.M.), UG1CA233327, UG1CA233337, UG1CA189858, U10CA180888 SWOG (to A.H.), K07CA197077 (to E.L.V.B.), R01CA118553 (to C.S.F. and F.-S.O.), and R01CA205406 (to K.N.). CALGB 89803 clinical trial was supported in part by funds from Pharmacia & Upjohn Company (now Pfizer Oncology; https://acknowledgments.alliancefound.org). K.N. was supported in part by Department of Defense grant CA160344 and the Project P Fund. J.A.M. was supported by the Douglas Gray Woodruff Chair Fund, the Guo Shu Shi Fund, Anonymous Family Fund for Innovations in Colorectal Cancer, Project P Fund, and the George Stone Family Foundation. C.S.F. was supported in part by a Stand Up To Cancer Colorectal Cancer Dream Team Translational Research Grant (SU2C-AACR-DT22-17). Research grants are administered by the American Association for Cancer Research, the Scientific Partner of SU2C.
Publisher Copyright:
© 2022 by American Society of Clinical Oncology.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION Diet and lifestyle factors further inform current recurrence and survival prediction models for patients with stage III colon cancer.
AB - PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION Diet and lifestyle factors further inform current recurrence and survival prediction models for patients with stage III colon cancer.
UR - http://www.scopus.com/inward/record.url?scp=85125290434&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85125290434&partnerID=8YFLogxK
U2 - 10.1200/JCO.21.01784
DO - 10.1200/JCO.21.01784
M3 - Article
C2 - 34995084
AN - SCOPUS:85125290434
VL - 40
SP - 740
EP - 751
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
SN - 0732-183X
IS - 7
ER -