Adherence to a healthy lifestyle in relation to colorectal cancer incidence and all-cause mortality after endoscopic polypectomy: a prospective study in three U.S. cohorts
Menée auprès de 24 668 personnes ayant subi une polypectomie endoscopique (durée médiane de suivi : 10 ans), cette étude analyse l'association entre un score évaluant le mode de vie sain (indice de masse corporelle, tabagisme, activité physique, consommation d'alcool et alimentation) et l'incidence du cancer colorectal (161 cas) ainsi que la mortalité toutes causes confondues
It remains unknown whether maintenance of a healthy lifestyle after endoscopic polypectomy could still confer benefit for colorectal cancer (CRC) incidence and mortality. In this study, we defined a healthy lifestyle score based on body mass index, smoking, physical activity, alcohol consumption, and diet (range, 0-5). We used Cox proportional hazards regression to estimate the hazard ratios (HRs) for the associations of healthy lifestyle score and individual lifestyle factors with CRC incidence and all-cause mortality. During a median of 10 years of follow-up of 24668 participants who underwent endoscopic polypectomy, we documented 161 CRC cases and 4857 all-cause deaths. A higher healthy lifestyle score after endoscopic polypectomy was associated with lower risk of CRC and all-cause mortality. Compared to individuals with 0-1 healthy lifestyle factors, those with 2, 3, and 4-5 healthy lifestyle factors had a HR for CRC risk of 0.86 [95% confidence interval (CI), 0.60-1.24], 0.73 (95% CI, 0.47-1.14), and 0.52 (95% CI, 0.27-1.01), respectively (Ptrend=0.03). The corresponding HR (95% CI) for all-cause mortality was 0.83 (95% CI, 0.76-0.90), 0.63 (95% CI, 0.56-0.70), and 0.56 (95% CI, 0.48-0.65), respectively (Ptrend<0.0001). In the joint analysis of pre- and post-polypectomy periods, patients with a healthy post-polypectomy lifestyle had a lower incidence of CRC regardless of their pre-polypectomy exposure, whereas those with a healthy lifestyle in both periods had a lower mortality than those with an unhealthy lifestyle in either period. In conclusion, adherence to a healthy lifestyle after polypectomy may confer significant benefit for CRC prevention and reduction in all-cause mortality.