Diet- and Lifestyle-Based Prediction Models to Estimate Cancer Recurrence and Death in Patients With Stage III Colon Cancer (CALGB 89803/Alliance)

En Cheng; Fang Shu Ou; Chao Ma; Donna Spiegelman; Sui Zhang; Xin Zhou; Tiffany M. Bainter; Leonard B. Saltz; Donna Niedzwiecki; Robert J. Mayer; Renaud Whittom; Alexander Hantel; Benson Al Benson; Daniel Atienza; Michael Messino; Hedy Kindler; Edward L. Giovannucci; Erin L. Van Blarigan; Justin C. Brown; Kimmie Ng; Cary P. Gross; Jeffrey A. Meyerhardt; Charles S. Fuchs

doi:10.1200/JCO.21.01784

Diet- and Lifestyle-Based Prediction Models to Estimate Cancer Recurrence and Death in Patients With Stage III Colon Cancer (CALGB 89803/Alliance)

En Cheng, Fang Shu Ou, Chao Ma, Donna Spiegelman, Sui Zhang, Xin Zhou, Tiffany M. Bainter, Leonard B. Saltz, Donna Niedzwiecki, Robert J. Mayer, Renaud Whittom, Alexander Hantel, Benson Al Benson, Daniel Atienza, Michael Messino, Hedy Kindler, Edward L. Giovannucci, Erin L. Van Blarigan, Justin C. Brown, Kimmie NgCary P. Gross, Jeffrey A. Meyerhardt, Charles S. Fuchs^*

^*Corresponding author for this work

Medicine, Hematology Oncology Division

Research output: Contribution to journal › Article › peer-review

27 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	740-751
Number of pages	12
Journal	Journal of Clinical Oncology
Volume	40
Issue number	7
DOIs	https://doi.org/10.1200/JCO.21.01784
State	Published - Mar 1 2022

Funding

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. 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.

ASJC Scopus subject areas

Oncology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1200/JCO.21.01784

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Cheng, E., Ou, F. S., Ma, C., Spiegelman, D., Zhang, S., Zhou, X., Bainter, T. M., Saltz, L. B., Niedzwiecki, D., Mayer, R. J., Whittom, R., Hantel, A., Al Benson, B., Atienza, D., Messino, M., Kindler, H., Giovannucci, E. L., Van Blarigan, E. L., Brown, J. C., ... Fuchs, C. S. (2022). Diet- and Lifestyle-Based Prediction Models to Estimate Cancer Recurrence and Death in Patients With Stage III Colon Cancer (CALGB 89803/Alliance). Journal of Clinical Oncology, 40(7), 740-751. https://doi.org/10.1200/JCO.21.01784

@article{b602a5a9d63b43daaf98f479008db857,

title = "Diet- and Lifestyle-Based Prediction Models to Estimate Cancer Recurrence and Death in Patients With Stage III Colon Cancer (CALGB 89803/Alliance)",

abstract = "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.",

author = "En Cheng and Ou, {Fang Shu} and Chao Ma and Donna Spiegelman and Sui Zhang and Xin Zhou and Bainter, {Tiffany M.} and Saltz, {Leonard B.} and Donna Niedzwiecki and Mayer, {Robert J.} and Renaud Whittom and Alexander Hantel and {Al Benson}, Benson and Daniel Atienza and Michael Messino and Hedy Kindler and Giovannucci, {Edward L.} and {Van Blarigan}, {Erin L.} and Brown, {Justin C.} and Kimmie Ng and Gross, {Cary P.} and Meyerhardt, {Jeffrey A.} and Fuchs, {Charles S.}",

note = "Publisher Copyright: {\textcopyright} 2022 by American Society of Clinical Oncology.",

year = "2022",

month = mar,

day = "1",

doi = "10.1200/JCO.21.01784",

language = "English (US)",

volume = "40",

pages = "740--751",

journal = "Journal of Clinical Oncology",

issn = "0732-183X",

publisher = "Lippincott Williams and Wilkins",

number = "7",

}

Cheng, E, Ou, FS, Ma, C, Spiegelman, D, Zhang, S, Zhou, X, Bainter, TM, Saltz, LB, Niedzwiecki, D, Mayer, RJ, Whittom, R, Hantel, A, Al Benson, B, Atienza, D, Messino, M, Kindler, H, Giovannucci, EL, Van Blarigan, EL, Brown, JC, Ng, K, Gross, CP, Meyerhardt, JA & Fuchs, CS 2022, 'Diet- and Lifestyle-Based Prediction Models to Estimate Cancer Recurrence and Death in Patients With Stage III Colon Cancer (CALGB 89803/Alliance)', Journal of Clinical Oncology, vol. 40, no. 7, pp. 740-751. https://doi.org/10.1200/JCO.21.01784

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.

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.

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SN - 0732-183X

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JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

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ER -

Diet- and Lifestyle-Based Prediction Models to Estimate Cancer Recurrence and Death in Patients With Stage III Colon Cancer (CALGB 89803/Alliance)

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