Prediagnostic smoking history, alcohol consumption, and colorectal cancer survival
Phipps AI et al. - In addition to an association with disease risk, smoking is associated with increased mortality after colorectal cancer diagnosis. This association is especially pronounced for colorectal cancer with high microsatellite instability.
Men and women diagnosed with incident colorectal cancer between 1998 and 2007 in 13 counties in western Washington State identified by using Surveillance, Epidemiology, and End Results cancer registry
Information on smoking history and alcohol consumption collected by telephone interview
Follow-up for mortality completed through linkage to National Death Index
Cox proportional hazards regression used to estimate HR and 95% CI for associations among smoking, alcohol consumption, and mortality after colorectal cancer diagnosis
Stratified analyses conducted by sex, age at diagnosis (<50 years, ≥50 years), tumor site (proximal, distal, rectal), stage (I-II, III-IV), and microsatellite instability status (stable/low, high)
Disease-specific and all-cause mortality significantly higher for smokers (HR, 1.30; 95% CI, 1.09-1.74) compared with never-smokers (HR, 1.51; 95% CI, 1.24-1.83)
Association most prominent in those with tumors exhibiting high microsatellite instability (HR, 3.83; 95% CI, 1.32-11.11) and did not extend to those with rectal cancer (HR, 1.08; 95% CI, 0.72-1.61) or those diagnosed before age 50 years (HR, 0.99; 95% CI, 0.67-1.48)
Alcohol consumption not associated with disease-specific or all-cause mortality, regardless of patient or tumor characteristics
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