Alcohol consumption and colon cancer prognosis among participants in north central cancer treatment group phase III trial N0147

Abstract

Alcohol consumption is associated with a modest increased risk of colon cancer, but its relationship with colon cancer survival has not been elucidated. Using data from a phase III randomized adjuvant trial, we assessed the association of alcohol consumption with colon cancer outcomes. Patients completed a risk factor questionnaire before randomization to FOLFOX or FOLFOX + cetuximab (N = 1984). Information was collected on lifestyle factors, including smoking, physical activity and consumption of different types of alcohol. Cox models assessed the association between alcohol consumption and outcomes of disease-free survival (DFS), time-to-recurrence (TTR) and overall survival (OS), adjusting for age, sex, study arm, body mass, smoking, physical activity and performance status. No statistically significant difference in outcomes between ever and never drinkers were noted [hazard ratio (HR)DFS = 0.86, HRTTR = 0.87, HROS = 0.86, p-values = 0.11-0.17]. However, when considering alcohol type, ever consumers of red wine (n = 628) had significantly better outcomes than never consumers (HRDFS = 0.80, HRTTR = 0.81, HROS = 0.78, p-values = 0.01-0.02). Favorable outcomes were confirmed in patients who consumed 1-30 glasses/month of red wine (n = 601, HR = 0.80-0.83, p-values = 0.03-0.049); there was a suggestion of more favorable outcomes in patients who consumed >30 glasses/month of red wine (n = 27, HR = 0.33-0.38, p-values = 0.05-0.06). Beer and liquor consumption were not associated with outcomes. Although alcohol consumption was not associated with colon cancer outcomes overall, mild to moderate red wine consumption was suggestively associated with longer OS, DFS and TTR in stage III colon cancer patients.

Keywords: alcohol; colon cancer; recurrence; red wine; survival.

Figure 1

Derivations of translational analytic cohort in North Central Cancer Treatment Group Phase III Trial N0147

Figure 2

Colon cancer outcomes by lifetime average monthly wine consumption: (A) disease-free survival by red wine consumption, (B) disease-free survival by white wine consumption, (C) overall survival by red wine consumption, (D) overall survival by white wine consumption, (E) time-to-recurrence by red wine consumption, (F) time-to-recurrence by white wine consumption. Disease-free survival is defined as the time from randomization to the first documented cancer recurrence or death from any cause, whichever came first. Overall survival was defined as the time from randomization to death from any cause. Time-to-recurrence was defined as the time from randomization to first documented disease recurrence. Never consumers include those who reported that they had never consumed red wine or white wine on a regular basis at any time prior to study enrollment.

Figure 3

Comparison of disease-free survival in ever versus never consumers (lifetime) of red wine according to patient and tumor characteristics. Analyses adjusted for age, treatment, sex, smoking history, performance score, physical activity, and BMI. Disease-free survival is defined as the time from randomization to the first documented cancer recurrence or death from any cause, whichever came first. Ever consumers of red wine include those who reported that they had consumed red wine on a regular basis (≥1 serving/month) at any time prior to study enrollment. Abbreviations: wt, wildtype; mut, mutated; pMMR, proficient mismatch repair; dMMR, deficient mismatch repair; BMI, body mass index; HR, hazard ratio; CI, confidence interval.