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.

FIG 1.

Nomogram for 5-year DFS. BMI, body mass index; COX-2, cyclooxygenase-2; CRC, colorectal cancer; DFS, disease-free survival; ECOG, Eastern Cooperative Oncology Group; MET, metabolic equivalent task; T/F, transverse/flexure.

FIG 2.

Nomogram for 5-year OS. BMI, body mass index; COX-2, cyclooxygenase-2; CRC, colorectal cancer; ECOG, Eastern Cooperative Oncology Group; MET, metabolic equivalent task; OS, overall survival; T/F, transverse/flexure.

FIG 3.

(A) Five-year predicted disease-free survival rates of patients with different clinical, pathologic, diet, and lifestyle characteristics. (B) Five-year predicted overall survival rates of patients with different clinical, pathologic, diet, and lifestyle characteristics. DFS, disease-free survival; OS, overall survival.