ASPO Abstracts
Alcohol, smoking, and risk of colorectal cancer recurrence and all-cause mortality: Results from the ColoCare Study
Category: Lifestyles Behavior, Energy Balance & Chemoprevention
Conference Year: 2022
Abstract Body:
PurposeWe sought to assess the association of pre-diagnostic alcohol consumption and smoking history with colorectal cancer (CRC) mortality and recurrence, using a large, prospective cohort of CRC patients.MethodsWe included men and women diagnosed with a new primary invasive CRC diagnosed 2007-2021 from the ColoCare Study, an ongoing multi-center prospective cohort study with six sites in the United States. We analyzed smoking history (never/ever), smoking recency (never/former/current), and current alcohol consumption (no/yes) at diagnosis. Primary outcomes included CRC recurrence and death from any cause. Multiple imputation by chained equations was used to impute missing values for covariates. Cox proportional hazards models were fit on imputed datasets, with estimates pooled using Rubin's rules. Participants with a history of alcohol abuse (n=24), unknown stage (n=386), or missing time to event or censoring were excluded from all analyses (recurrence n=535; mortality n=16). Participants with stage IV cancer (n=425) or a recurrence within 3 months from diagnosis (n=80) were excluded from recurrence analyses. All models were adjusted for sex, stage at diagnosis, race (white, non-white), ethnicity (non-Hispanic, Hispanic), history of diabetes, history of high cholesterol, history of hypertension, and body mass index, with mutual adjustment for alcohol and smoking history. Effect modification by sex, tumor site, tumor side, and age at diagnosis was explored.ResultsThe median follow-up time for 2,219 CRC patients was two years for recurrence analyses and 2.38 years for all-cause mortality analyses. There were 235 recurrences and 467 deaths over follow-up. We observed no associations between current alcohol consumption, smoking history, or recency of smoking at diagnosis and CRC recurrence or all-cause mortality, respectively. No evidence of effect modification was observed.ConclusionIn this prospective cohort, we found no evidence of an association between pre-diagnostic alcohol consumption or smoking and risk of CRC recurrence or all-cause mortality. This adds to the literature on the effects of these modifiable factors and CRC outcomes and supports the prioritization of research on other behavioral interventions to improve CRC outcomes.
Keywords: colorectal cancer, outcomes, alcohol, smoking