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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., Competing Interests: En ChengStock and Other Ownership Interests: Pfizer Fang-Shu OuConsulting or Advisory Role: SC Liver Research Consortium Leonard B. SaltzResearch Funding: Taiho Pharmaceutical Robert J. MayerConsulting or Advisory Role: Bayer Renaud WhittomConsulting or Advisory Role: AstraZenecaResearch Funding: Canadian Cancer Trials Group (Inst) Al BensonConsulting or Advisory Role: Merck Sharp & Dohme, Array BioPharma, Bristol Myers Squibb, Samsung Bioepis, Pfizer, HalioDx, AbbVie, Janssen Oncology, Natera, Apexigen, Artemida Pharma, Xencor, Therabionic, Mirati Therapeutics, Boston ScientificResearch Funding: Infinity Pharmaceuticals (Inst), Merck Sharp & Dohme (Inst), Taiho Pharmaceutical (Inst), Bristol Myers Squibb (Inst), Celgene (Inst), Rafael Pharmaceuticals (Inst), MedImmune (Inst), Xencor (Inst), Astellas Pharma (Inst), Amgen (Inst), Syncore (Inst), Elevar Therapeutics (Inst), Tyme Inc (Inst), ST Pharm (Inst), ITM Solucin (Inst) Daniel AtienzaEmployment: US Oncology Hedy KindlerHonoraria: AstraZenecaConsulting or Advisory Role: AstraZeneca, Bristol Myers Squibb, Deciphera, Novocure, Seattle Genetics, InhibrxResearch Funding: Aduro Biotech (Inst), AstraZeneca (Inst), GlaxoSmithKline (Inst), Merck (Inst), Verastem (Inst), Bristol Myers Squibb (Inst), Polaris (Inst), Deciphera (Inst), Inhibrx (Inst), Roche/Genentech (Inst), Tesaro (Inst), Macrogenics (Inst), Leap Therapeutics (Inst), Fibrogen (Inst), Vivace Therapeutics (Inst), Constellation Pharmaceuticals (Inst), Harpoon therapeutics (Inst), Bayer (Inst), Seattle Genetics (Inst), Blueprint Medicines (Inst)Travel, Accommodations, Expenses: AstraZeneca Kimmie NgConsulting or Advisory Role: Seattle Genetics, X-Biotix Therapeutics, Array BioPharma, BiomX, Bicara TherapeuticsResearch Funding: Pharmavite (Inst), Revolution Medicines (Inst), Evergrande Group (Inst), Janssen (Inst) Cary P. GrossResearch Funding: Johnson & Johnson (Inst), AstraZeneca (Inst), GenentechUncompensated Relationships: Genentech (Inst) Jeffrey A. MeyerhardtHonoraria: Cota Healthcare, Taiho PharmaceuticalResearch Funding: Boston Biomedical (Inst) Charles S. FuchsEmployment: Genentech/RocheLeadership: CytomX Therapeutics, Evolveimmune TherapeuticsStock and Other Ownership Interests: CytomX Therapeutics, Entrinsic Health, Evolveimmune Therapeutics, Roche/GenentechConsulting or Advisory Role: Sanofi, Merck, Entrinsic Health, Agios, Taiho Pharmaceutical, Genentech/Roche, CytomX Therapeutics, Unum Therapeutics, Bain Capital, Lilly, Amylin, Daiichi-Sankyo, Evolveimmune Therapeutics, AstraZeneca, AstraZenecaExpert Testimony: Lilly, AmylinNo other potential conflicts of interest were reported.

Purpose Observational studies have reported increased colon cancer recurrence and mortality in patients with states of hyperinsulinemia, including type 2 diabetes, obesity, sedentary lifestyle, and high glycemic load diet. Nut intake has been associated with a lower risk of type 2 diabetes, metabolic syndrome, and insulin resistance. However, the effect of nut intake on colon cancer recurrence and survival is not known. Patients and Methods We conducted a prospective, observational study of 826 eligible patients with stage III colon cancer who reported dietary intake on food frequency questionnaires while enrolled onto a randomized adjuvant chemotherapy trial. Using Cox proportional hazards regression, we assessed associations of nut intake with cancer recurrence and mortality. Results After a median follow-up of 6.5 years, compared with patients who abstained from nuts, individuals who consumed two or more servings of nuts per week experienced an adjusted hazard ratio (HR) for disease-free survival of 0.58 (95% CI, 0.37 to 0.92; P trend = .03) and an HR for overall survival of 0.43 (95% CI, 0.25 to 0.74; P trend = .01). In subgroup analysis, the apparent benefit was confined to tree nut intake (HR for disease-free survival, 0.54; 95% CI, 0.34 to 0.85; P trend = .04; and HR for overall survival, 0.47; 95% CI, 0.27 to 0.82; P trend = .04). The association of total nut intake with improved outcomes was maintained across other known or suspected risk factors for cancer recurrence and mortality. Conclusion Diets with a higher consumption of nuts may be associated with a significantly reduced incidence of cancer recurrence and death in patients with stage III colon cancer.

Purpose: Observational studies have demonstrated increased colon cancer recurrence in states of relative hyperinsulinemia, including sedentary lifestyle, obesity, and increased dietary glycemic load. Greater coffee consumption has been associated with decreased risk of type 2 diabetes and increased insulin sensitivity. The effect of coffee on colon cancer recurrence and survival is unknown., Patients and Methods: During and 6 months after adjuvant chemotherapy, 953 patients with stage III colon cancer prospectively reported dietary intake of caffeinated coffee, decaffeinated coffee, and nonherbal tea, as well as 128 other items. We examined the influence of coffee, nonherbal tea, and caffeine on cancer recurrence and mortality using Cox proportional hazards regression., Results: Patients consuming 4 cups/d or more of total coffee experienced an adjusted hazard ratio (HR) for colon cancer recurrence or mortality of 0.58 (95% CI, 0.34 to 0.99), compared with never drinkers (Ptrend = .002). Patients consuming 4 cups/d or more of caffeinated coffee experienced significantly reduced cancer recurrence or mortality risk compared with abstainers (HR, 0.48; 95% CI, 0.25 to 0.91; Ptrend = .002), and increasing caffeine intake also conferred a significant reduction in cancer recurrence or mortality (HR, 0.66 across extreme quintiles; 95% CI, 0.47 to 0.93; Ptrend = .006). Nonherbal tea and decaffeinated coffee were not associated with patient outcome. The association of total coffee intake with improved outcomes seemed consistent across other predictors of cancer recurrence and mortality., Conclusion: Higher coffee intake may be associated with significantly reduced cancer recurrence and death in patients with stage III colon cancer., (© 2015 by American Society of Clinical Oncology.)