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Dietary glycemic and insulin scores and colorectal cancer survival by tumor molecular biomarkers
Author(s) -
Keum NaNa,
Yuan Chen,
Nishihara Reiko,
Zoltick Emilie,
Hamada Tsuyoshi,
Martinez Fernandez Alejandro,
Zhang Xuehong,
Hanyuda Akiko,
Liu Li,
Kosumi Keisuke,
Nowak Jonathan A.,
Jhun Iny,
Soong T. Rinda,
Morikawa Teppei,
Tabung Fred K.,
Qian Zhi Rong,
Fuchs Charles S.,
Meyerhardt Jeffrey A.,
Chan Andrew T.,
Ng Kimmie,
Ogino Shuji,
Giovannucci Edward L.,
Wu Kana
Publication year - 2017
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.30683
Subject(s) - medicine , hazard ratio , colorectal cancer , insulin , kras , oncology , glycemic , proportional hazards model , glycemic index , glycemic load , cancer , confidence interval , endocrinology , type 2 diabetes , insulin receptor , insulin resistance , diabetes mellitus
Accumulating evidence suggests that post‐diagnostic insulin levels may influence colorectal cancer (CRC) survival. Yet, no previous study has examined CRC survival in relation to a post‐diagnostic diet rich in foods that increase post‐prandial insulin levels. We hypothesized that glycemic and insulin scores (index or load; derived from food frequency questionnaire data) may be associated with survival from specific CRC subtypes sensitive to the insulin signaling pathway. We prospectively followed 1,160 CRC patients from the Nurses' Health Study (1980–2012) and Health Professionals Follow‐Up Study (1986–2012), resulting in 266 CRC deaths in 10,235 person‐years. CRC subtypes were defined by seven tumor biomarkers ( KRAS, BRAF, PIK3CA mutations, and IRS1, IRS2, FASN and CTNNB1 expression) implicated in the insulin signaling pathway. For overall CRC and each subtype, hazard ratio (HR) and 95% confidence interval (95% CI) for an increase of one standard deviation in each of glycemic and insulin scores were estimated using time‐dependent Cox proportional hazards model. We found that insulin scores, but not glycemic scores, were positively associated with CRC mortality (HR = 1.19, 95% CI = 1.02–1.38 for index; HR = 1.23, 95% CI = 1.04–1.47 for load). The significant positive associations appeared more pronounced among PIK3CA wild‐type cases and FASN‐negative cases, with HR ranging from 1.36 to 1.60 across insulin scores. However, we did not observe statistically significant interactions of insulin scores with PIK3CA , FASN, or any other tumor marker ( p interaction > 0.12). While additional studies are needed for definitive evidence, a high‐insulinogenic diet after CRC diagnosis may contribute to worse CRC survival.