Alcohol Consumption and Smoking History at the Time of Diagnosis and the Risk of Colorectal Cancer Recurrence and Mortality: Results from the ColoCare Study

Overview

Journal Cancer Epidemiol Biomarkers Prev

Specialties Biochemistry
Oncology
Public Health

Date 2024 Oct 7

PMID 39373623

Authors

Nicole C Lorona

Caroline Himbert

Jennifer Ose

Stacey A Cohen

Ildiko Strehli

Cornelia M Ulrich

Sofia Cobos

Esther Jean-Baptiste

Amanda M Bloomer

Jane C Figueiredo

Biljana Gigic

Sheetal Hardikar

Meghana Karchi

Matthew Mutch

Anita R Peoples

Martin Schneider

David Shibata

Erin M Siegel

Adetunji T Toriola

Elizabeth H Wood

Christopher I Li

Affiliations

Soon will be listed here.

Abstract

Background: Findings from studies investigating the impacts of alcohol use and smoking on colorectal cancer outcomes are inconclusive. This study aimed to investigate associations between alcohol use and smoking status at the time of diagnosis on recurrence and overall mortality among patients with colorectal cancer.

Methods: The present study included 2,216 stage I-IV patients with colorectal cancer from the longitudinal multicenter ColoCare Study, with available data on recurrence and colorectal cancer-specific mortality. Cox proportional hazards models adjusted for age, sex, race, ethnicity, stage, tumor site, treatment, comorbidities, body mass index, and study site were fit, with imputations for missing data.

Results: We observed 235 recurrences and 308 colorectal cancer-specific deaths over an average of 3 years of follow-up. After adjusting for confounders, current alcohol consumption and ever smoking, relative to not current consumption and never smoking, respectively, were not statistically significantly associated with colorectal cancer recurrence [alcohol-HR, 0.95. 95% confidence interval (CI), 0.71-1.29; ever smoking-HR, 0.98, 95% CI, 0.75-1.29] or colorectal cancer-specific mortality (alcohol-HR, 0.95. 95% CI, 0.74-1.22; ever smoking-HR, 0.98, 95% CI, 0.77-1.24).

Conclusions: No associations were observed between alcohol and smoking at diagnosis and clinical outcomes in this well-annotated longitudinal cohort.

Impact: Our cohort study reports no significant associations; however, limiting alcohol use and avoiding smoking are health behaviors recommended for colorectal cancer survivors for prevention of other cancers and chronic conditions.

References

Walter V, Jansen L, Ulrich A, Roth W, Blaker H, Chang-Claude J . Alcohol consumption and survival of colorectal cancer patients: a population-based study from Germany. Am J Clin Nutr. 2016; 103(6):1497-506. DOI: 10.3945/ajcn.115.127092. View

van Zutphen M, Boshuizen H, Kenkhuis M, Wesselink E, Geijsen A, de Wilt J . Lifestyle after colorectal cancer diagnosis in relation to recurrence and all-cause mortality. Am J Clin Nutr. 2021; 113(6):1447-1457. PMC: 8168353. DOI: 10.1093/ajcn/nqaa394. View

Heinzerling J, Anthony T, Livingston E, Huerta S . Predictors of distant metastasis and mortality in patients with stage II colorectal cancer. Am Surg. 2007; 73(3):230-8. View

Hou L, Jiang J, Liu B, Nasca P, Wu Y, Zou X . Association between smoking and deaths due to colorectal malignant carcinoma: a national population-based case-control study in China. Br J Cancer. 2014; 110(5):1351-8. PMC: 3950885. DOI: 10.1038/bjc.2014.9. View

El-Shami K, Oeffinger K, Erb N, Willis A, Bretsch J, Pratt-Chapman M . American Cancer Society Colorectal Cancer Survivorship Care Guidelines. CA Cancer J Clin. 2015; 65(6):428-55. PMC: 5385892. DOI: 10.3322/caac.21286. View

Zheng K, Yu J, Chen Z, Zhou R, Lin C, Zhang Y . Ethanol promotes alcohol-related colorectal cancer metastasis via the TGF-β/RUNX3/Snail axis by inducing TGF-β1 upregulation and RUNX3 cytoplasmic mislocalization. EBioMedicine. 2019; 50:224-237. PMC: 6921366. DOI: 10.1016/j.ebiom.2019.11.011. View

Croese A, Gartrell R, Hiscock R, Lee M, Gibbs P, Faragher I . The effect of smoking, obesity and diabetes on recurrence-free and overall survival in patients with stage III colon cancer receiving adjuvant chemotherapy. Cancer Rep (Hoboken). 2021; 4(3):e1346. PMC: 8222556. DOI: 10.1002/cnr2.1346. View

Sharp L, McDevitt J, Brown C, Comber H . Smoking at diagnosis significantly decreases 5-year cancer-specific survival in a population-based cohort of 18 166 colon cancer patients. Aliment Pharmacol Ther. 2017; 45(6):788-800. DOI: 10.1111/apt.13944. View

Sharp L, McDevitt J, Brown C, Carsin A, Comber H . Association between smoking at diagnosis and cause-specific survival in patients with rectal cancer: Results from a population-based analysis of 10,794 cases. Cancer. 2017; 123(13):2543-2550. DOI: 10.1002/cncr.30583. View

10.

Ulrich C, Gigic B, Bohm J, Ose J, Viskochil R, Schneider M . The ColoCare Study: A Paradigm of Transdisciplinary Science in Colorectal Cancer Outcomes. Cancer Epidemiol Biomarkers Prev. 2018; 28(3):591-601. PMC: 6420345. DOI: 10.1158/1055-9965.EPI-18-0773. View

11.

Jayasekara H, English D, Haydon A, Hodge A, Lynch B, Rosty C . Associations of alcohol intake, smoking, physical activity and obesity with survival following colorectal cancer diagnosis by stage, anatomic site and tumor molecular subtype. Int J Cancer. 2017; 142(2):238-250. DOI: 10.1002/ijc.31049. View

12.

Breslow R, Chen C, Graubard B, Mukamal K . Prospective study of alcohol consumption quantity and frequency and cancer-specific mortality in the US population. Am J Epidemiol. 2011; 174(9):1044-53. PMC: 3243934. DOI: 10.1093/aje/kwr210. View

13.

Shaukat A, Dostal A, Menk J, Church T . BMI Is a Risk Factor for Colorectal Cancer Mortality. Dig Dis Sci. 2017; 62(9):2511-2517. DOI: 10.1007/s10620-017-4682-z. View

14.

Munro A, Bentley A, Ackland C, Boyle P . Smoking compromises cause-specific survival in patients with operable colorectal cancer. Clin Oncol (R Coll Radiol). 2006; 18(6):436-40. DOI: 10.1016/j.clon.2006.04.009. View

15.

Zhu Y, Yang S, Wang P, Savas S, Wish T, Green R . Influence of pre-diagnostic cigarette smoking on colorectal cancer survival: overall and by tumour molecular phenotype. Br J Cancer. 2014; 110(5):1359-66. PMC: 3950884. DOI: 10.1038/bjc.2014.6. View

16.

Tamakoshi A, Nakamura K, Ukawa S, Okada E, Hirata M, Nagai A . Characteristics and prognosis of Japanese colorectal cancer patients: The BioBank Japan Project. J Epidemiol. 2017; 27(3S):S36-S42. PMC: 5350596. DOI: 10.1016/j.je.2016.12.004. View

17.

Yang B, Jacobs E, Gapstur S, Stevens V, Campbell P . Active smoking and mortality among colorectal cancer survivors: the Cancer Prevention Study II nutrition cohort. J Clin Oncol. 2015; 33(8):885-93. DOI: 10.1200/JCO.2014.58.3831. View

18.

Xiang T, Fei R, Wang Z, Shen Z, Qian J, Chen W . Nicotine enhances invasion and metastasis of human colorectal cancer cells through the nicotinic acetylcholine receptor downstream p38 MAPK signaling pathway. Oncol Rep. 2015; 35(1):205-10. DOI: 10.3892/or.2015.4363. View

19.

Islami F, Sauer A, Miller K, Siegel R, Fedewa S, Jacobs E . Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2017; 68(1):31-54. DOI: 10.3322/caac.21440. View

20.

Azur M, Stuart E, Frangakis C, Leaf P . Multiple imputation by chained equations: what is it and how does it work?. Int J Methods Psychiatr Res. 2011; 20(1):40-9. PMC: 3074241. DOI: 10.1002/mpr.329. View