Dietary Insulin Load and Cancer Recurrence and Survival in Patients With Stage III Colon Cancer: Findings From CALGB 89803 (Alliance).

Abstract

BACKGROUND:

Evidence suggests that diets inducing postprandial hyperinsulinemia may be associated with increased cancer-related mortality. The goal of this study was to assess the influence of postdiagnosis dietary insulin load and dietary insulin index on outcomes of stage III colon cancer patients.

METHODS:

We conducted a prospective observational study of 1023 patients with resected stage III colon cancer enrolled in an adjuvant chemotherapy trial who reported dietary intake halfway through and six months after chemotherapy. We evaluated the association of dietary insulin load and dietary insulin index with cancer recurrence and survival using Cox proportional hazards regression adjusted for potential confounders; statistical tests were two-sided.

RESULTS:

High dietary insulin load had a statistically significant association with worse disease-free survival (DFS), comparing the highest vs lowest quintile (adjusted hazard ratio [HR] = 2.77, 95% confidence interval [CI] = 1.90 to 4.02, Ptrend < .001). High dietary insulin index was also associated with worse DFS (highest vs lowest quintile, HR = 1.75, 95% CI = 1.22 to 2.51, Ptrend= .01). The association between higher dietary insulin load and worse DFS differed by body mass index and was strongest among patients with obesity (HR = 3.66, 95% CI = 1.88 to 7.12, Pinteraction = .04). The influence of dietary insulin load on cancer outcomes did not differ by mutation status of KRAS, BRAF, PIK3CA, TP53, or microsatellite instability.

CONCLUSIONS:

Patients with resected stage III colon cancer who consumed a high-insulinogenic diet were at increased risk of recurrence and mortality. These findings support the importance of dietary management following resection of colon cancer, and future research into underlying mechanisms of action is warranted.

• Authors: Vicente Morales-Oyarvide, Chen Yuan, Ana Babic, Sui Zhang, Donna Niedzwiecki, Jennie C Brand-Miller, Laura Sampson-Kent, Xing Ye, Yanping Li, Leonard B Saltz, Robert J Mayer, Rex B Mowat, Renaud Whittom, Alexander Hantel, Al Benson, Daniel Atienza, Michael Messino, Hedy Kindler, Alan Venook, Shuji Ogino, Kana Wu, Walter C Willett, Edward L Giovannucci, Brian M Wolpin, Jeffrey A Meyerhardt, Charles S Fuchs, Kimmie Ng
• Journal: Journal of the National Cancer Institute (J Natl Cancer Inst) Vol. 111 Issue 2 Pg. 170-179 (02 01 2019) ISSN: 1460-2105 [Electronic] United States
• PMID: 30726946 (Publication Type: Clinical Trial, Phase III, Journal Article, Observational Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected].

Chemical References

• Hypoglycemic Agents
• Insulin

Topics

• Adult
• Aged
• Aged, 80 and over
• Case-Control Studies
• Colonic Neoplasms (etiology, mortality, pathology)
• Diet (adverse effects)
• Female
• Follow-Up Studies
• Humans
• Hyperinsulinism (complications)
• Hypoglycemic Agents (adverse effects)
• Insulin (adverse effects)
• Male
• Middle Aged
• Neoplasm Recurrence, Local (etiology, mortality, pathology)
• Neoplasm Staging
• Prospective Studies
• Risk Factors
• Survival Rate