11 juni 2025: Bron: ASCO 2025 en CTSU/C80702 studie

Wanneer patiënten geopereerd aan dikkedarm kanker stadium III naast chemotherapie met FOLFOX + Celecoxib een ontstekingsremmend voedingspatroon plus regelmatig bewegen en sporten volgen dan bewerkstelligen zij een langere overall overleving en krijgen mindeer een recidief in vergelijking met de patiënten die een ontstekings stimulerend voedingspatroon volgden en beperkt bewogen.

Het verschil in kans op overlijden bedroeg maar liefst 87 procent tussen de hoogste en laagse zogeheten EDIP scores. En patiënten die een ontstekingsremmend voedingspatroon combineerden verlaagden het risico op overlijden aan de darmkanker met 69 procent in vergelijking met patiënten met de hoogste EDIP scores plus beperkt bewegen.

De EDIP-tool is een gewogen som van 18 voedselgroepen: 9 ontstekingsbevorderende en 9 ontstekingsremmnede. Voorbeelden van ontstekingsbevordernde voedingsmiddelen zijn rood vlees, bewerkt vlees, geraffineerde granen en suikerhoudende dranken. Voorbeelden van ontstekingsremmende voedingsmiddelen zijn koffie, thee, donkergele groenten en bladgroenten. Een hoge EDIP-score duidt op een ontstekingsbevorderend dieet. Een lage EDIP-score staat voor een ontstekingsremmend dieet.

Uit het studierapport vertaald:

Belangrijkste bevindingen:

Patiënten die de meeste pro-inflammatoire diëten gebruikten en de hoogste EDIP-scores hadden, waren:ouder in leeftijd (gemiddelde leeftijd 58,7 vs. 61,3)
vaker vrouw (64% vs. 48,9%)
hoger in een ECOG-score van 1 of 2, wat duidt op een verminderd vermogen om dagelijkse activiteiten uit te voeren (35,7% vs. 19,4%)
minder blanke mensen (76,6% vs. 92,0%) meer zwarte mensen (15,4% vs. 3,7%)
Pro-inflammatoire diëten waren geassocieerd met slechtere uitkomsten. Patiënten met de hoogste EDIP-scores en een zeer pro-inflammatoir dieet hadden een 87% hoger risico op overlijden dan patiënten met een sterk ontstekingsremmend dieet.
Bewegingsgewoonten, een andere beïnvloedbare factor die verband houdt met systemische ontsteking, hadden ook invloed op de algehele overleving. Patiënten die minder ontstekingsbevorderende diëten gebruikten en vaker bewogen (9 of meer metabole equivalente -uren per week) hadden de beste algehele overleving, met een 63% lager risico op overlijden vergeleken met patiënten die een pro-inflammatoir dieet volgden en minder bewogen (minder dan 9 MET-uren per week).
Er was geen significant verschil in ziektevrije overleving tussen de patiënten die een pro-inflammatoir dieet volgden en degenen die een anti-inflammatoir dieet volgden.
Het gebruik van lage doses aspirine en het behandelregime dat de patiënten kregen in het kader van de CALGB/SWOG 80702-studie verschilden niet significant tussen de groepen.

Het abstract van de studie werd gepresentaard op ASCO 2025: Zie dit persbericht, daaronder het abstract:

Pro-Inflammatory Diets Associated With Worse Outcomes for Patients with Stage III Colon Cancer

Jun 1, 2025

ASCO Perspective Quote

“This early but promising observational study suggests a powerful synergy: patients with stage III colon cancer who embraced anti-inflammatory foods and exercised regularly showed the best overall survival compared to those with inflammatory diets and limited exercise,” said Julie R. Gralow, MD, FACP, FASCO, ASCO Chief Medical Officer and Executive Vice President.

Study at-a-Glance

Focus	Stage III colon cancer that has been removed with surgery
Population	1,625 patients with an average age of around 61 years
Main Takeaways	Consuming a pro-inflammatory diet was associated with worse overall survival for patients with stage III colon cancer.
Significance	Stage III colon cancer has spread to nearby lymph nodes but not distant parts of the body. Most patients with stage III colon cancer will have surgery to remove tumors in their colon, which aims for a cure. However, 25% to 35% of patients with stage III colon cancer will see their cancer come back within 5 years of completing treatment. Chronic systemic inflammation is a known risk factor for developing colon cancer and for colon cancer progression. It has many possible causes, including certain chronic conditions such as diabetes and inflammatory bowel disease, as well as dietary, lifestyle and environmental factors. Recent studies have found that anti-inflammatory medications like aspirin can reduce the risk of developing colorectal cancer and cancer recurrence for certain subsets of patients with stage III colon cancer. Another recent study found that higher systemic inflammation after diagnosis was associated with poorer survival among patients with stage III colon cancer. To assess the effects of diet on the risk of colon cancer recurrence, the diet habits of a subset of patients enrolled in the phase 3 CALGB/SWOG 80702 clinical trial were analyzed. It compared patients with a more inflammatory diet and a less inflammatory diet and their outcomes.

CHICAGO — Results from a large, prospective cohort study show that eating a less inflammatory diet may reduce the risk of death for patients with stage III colon cancer. The research will be presented at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting, taking place May 30-June 3 in Chicago.

About the Study

"One of the most common questions that patients ask is what diet they should be following to maximally reduce their risk of cancer recurrence and improve survival. While there have been many studies examining dietary factors and the risk of developing colorectal cancer, there is significantly less known about how diet impacts colon cancer outcomes after diagnosis. This study sheds light on the relationship between dietary patterns and survival in patients with stage III colon cancer,” said lead study author Sara K. Char, MD, Dana-Farber Cancer Institute in Boston, Massachusetts.

To assess the effects of diet on the risk of colon cancer recurrence, the diet habits of a subset of patients enrolled in the phase 3 CALGB/SWOG 80702 clinical trial were analyzed in a prospective cohort study. The CALGB/SWOG 80702 clinical trial tested 3 months vs. 6 months of adjuvant chemotherapy, with or without celecoxib, an anti-inflammatory medication. A prospective cohort study follows patients with similar characteristics who differ in a key factor over time to see if that factor impacts outcomes.

Of the approximately 2,500 patients enrolled in CALGB/SWOG 80702, there were 1,625 patients followed as part of this study. The patients all had stage III colon cancer that had been removed with surgery. The average age of the participants was 60.9 years. The patients reported their diet and exercise habits at six weeks after being randomly assigned to a treatment group in the CALGB/SWOG 80702 study and again 14 to 16 months after random assignment. Their diets were scored using the empirical dietary inflammatory pattern (EDIP) tool.

The EDIP tool is a weighted sum of 18 food groups: 9 pro-inflammatory and 9 anti-inflammatory. Examples of pro-inflammatory foods include red meat, processed meats, refined grains and sugary drinks. Examples of anti-inflammatory foods include coffee, tea, dark yellow vegetables and leafy green vegetables. A high EDIP score indicates a pro-inflammatory diet. A low EDIP score represents a less inflammatory diet.

Key Findings

Patients who consumed the most pro-inflammatory diets and had the highest EDIP scores were:
- More likely to be younger (average age 58.7 vs. 61.3)
- More likely to be female (64% vs. 48.9%)
- Have an ECOG score of 1 or 2, indicating a lesser ability to perform daily activities (35.7% vs. 19.4%)
- Less likely to be White (76.6% vs. 92.0%)
- More likely to be Black (15.4% vs. 3.7%)
Pro-inflammatory diets were associated with worse outcomes. Patients with the highest EDIP scores and very pro-inflammatory diets had an 87% higher risk of death than those who ate highly anti-inflammatory diets.
Exercise habits, another modifiable factor associated with systemic inflammation, also impacted overall survival. Patients who consumed less inflammatory diets and exercised more often (9 or more metabolic equivalent hours per week) had the best overall survival, with 63% lower risk of death compared to patients who ate pro-inflammatory diets and exercised less (less than 9 MET hours pers week).
There was no significant difference in disease-free survival between the patients who ate a pro-inflammatory diet and those who ate an anti-inflammatory diet.
Low-dose aspirin use and which treatment regimen the patients received as part of the CALGB/SWOG 80702 trial were not significantly different between the groups.

Next Steps

Researchers will continue to study how diet and inflammation, as well as exercise, affect outcomes for patients with colorectal cancer.

This study was funded by the National Institutes of Health, Pfizer, and the Project P Fund.

View author disclosures

View the abstract

View the News Planning Team disclosures

Het abstract is dit:

Association between empirical dietary inflammatory pattern (EDIP) and survival in patients with stage III colon cancer: Findings from CALGB/SWOG 80702 (Alliance)

Authors

Sara Char, Qian Shi, Tyler Zemla, Chao Ma, En Cheng, Priya Kumthekar, Katherine Guthrie, Felix Couture, J. Kuebler, Pankaj Kumar, Benjamin Tan, Smitha Krishnamurthi, Brian Wolpin, Francois Geoffroy, Fred Tabung, Anthony Shields, Eileen O'Reilly, Jeffrey Meyerhardt, Chen Yuan, Kimmie Ng

Organizations

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, Northwestern Memorial Hospital, Chicago, IL, SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA, CHU de Québec, Quebec, QC, Canada, Columbus NCI Community Oncology Research Program, Columbus, OH, Illinois CancerCare, P.C., Peoria, IL, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, OH, Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY

Background:

Systemic inflammation has been implicated in colon cancer progression. We examined whether intake of a proinflammatory diet is associated with survival among patients (pts) with stage III colon cancer.

Methods:

This prospective cohort study was nested within a randomized phase III trial of adjuvant therapy in pts with stage III colon cancer who had undergone curative-intent resection. EDIP score – a validated tool to classify the inflammatory nature of diets – was derived as a cumulative exposure using data from food-frequency questionnaires completed within 6 weeks of randomization and 14-16 months (mo) after randomization. Cox proportional hazards regression was used to assess the associations of EDIP with disease-free survival (DFS) and overall survival (OS).

Results:

Of 1625 included pts, the mean (SD) age was 60.9 (10.5) years (yrs). Compared to pts in the lowest EDIP quintile, pts in the highest quintile (a more inflammatory diet) were younger (58.7 ± 10.8 vs 61.3 ± 9.5 yrs old) and more likely to be female (64.0% vs 48.9%) and have worse performance status (ECOG 1-2: 35.7% vs 19.4%). Pts in the highest quintile were less likely to be White (76.6% vs 92.0 %) and more likely to be Black (15.4% vs 3.7%). Baseline aspirin use, assigned chemotherapy (3 mo vs 6 mo), and assigned pharmacotherapy (celecoxib vs placebo) were not significantly different across EDIP quintiles. Compared with pts in the lowest EDIP quintile, pts in the highest quintile had significantly worse OS (multivariable hazard ratio 1.87, 95% confidence interval 1.26-2.77, Ptrend=0.01), but not DFS (HR 1.36, 95% CI 0.99-1.86, Ptrend=0.22). Diet and physical activity jointly influenced OS. Those with lower EDIP scores (quintiles 1-4, 80% of the study population) and higher physical activity (≥9 MET-h/wk) had the best OS (HR 0.37, 95% CI 0.25-0.53) compared with pts in the highest EDIP quintile (20% of the study population) and lower physical activity (<9 MET-h/wk) (Pinteraction <0.001). The association between higher EDIP and OS was consistent when analyzed by celecoxib and placebo treatment arms (Pinteraction 0.54). The relationship between EDIP and OS did not differ significantly according to aspirin use, with HR 1.60 (95% CI 0.71-3.60) among aspirin users and HR 2.01 (95% CI 1.27-3.16) among aspirin non-users (Pinteraction 0.06).

Conclusions:

Our findings suggest that greater intake of a proinflammatory dietary pattern is associated with worse OS in pts with stage III colon cancer. Regular physical activity may attenuate the association, and further investigation of diet and physical activity intervention is warranted. Support: U10CA180821, U10CA180882, U24CA196171, U10CA180863, CCS 707213, UG1CA233234, U10CA180820, U10CA180868, U10CA180888; https://acknowledgments.alliancefound.org. Pfizer; ClinicalTrials.gov Identifier: NCT01150045.

Abstract Disclosures