title: Associations of red and processed meat with survival after colorectal cancer and differences according to timing of dietary assessment.
abstract: BACKGROUND
  Little is known about the prognostic impact of red and processed meat intake or about changes in consumption after a diagnosis of colorectal cancer (CRC).
  
  
  OBJECTIVE
  We investigated associations of baseline red and processed meat with survival outcomes and explored changes in intake among CRC survivors 5 y after diagnosis.
  
  
  METHODS
  A total of 3122 patients diagnosed with CRC between 2003 and 2010 were followed for a median of 4.8 y [DACHS (Darmkrebs: Chancen der Verhütung durch Screening) study]. Patients provided information on diet and other factors in standardized questionnaires at baseline and at the 5-y follow-up. Cox proportional hazards regression models were used to estimate HRs and 95% CIs.
  
  
  RESULTS
  Among patients with stage I-III CRC, baseline red and processed meat intake was not associated with overall (>1 time/d compared with <1 time/d; HR: 0.85; 95% CI: 0.67, 1.09), CRC-specific (HR: 0.83; 95% CI: 0.61, 1.14), cardiovascular disease-specific (HR: 0.92; 95% CI: 0.51, 1.68), non-CRC-specific (HR: 0.88; 95% CI: 0.59, 1.30), and recurrence-free (HR: 1.03; 95% CI: 0.80, 1.33) survival; results among stage IV patients were comparable. An association with worse overall survival was found among patients with Kirsten rat sarcoma viral oncogene homolog (KRAS)-mutated CRC (HR: 1.99; 95% CI: 1.10, 3.56) but not with microsatellite instability or CpG island methylator phenotype (CIMP) positivity. A much lower proportion of survivors reported daily consumption of red and processed meat at the 5-y follow-up than at baseline (concordance rate: 39%; κ-value: 0.10; 95% CI: 0.07, 0.13).
  
  
  CONCLUSIONS
  Our findings suggest that baseline red and processed meat intake is not associated with poorer survival among patients with CRC. The potential interaction with KRAS mutation status warrants further evaluation. Major changes in consumption measured at the 5-y follow-up may have had an impact on our survival estimates.
authors.affiliation: Divisions of Clinical Epidemiology and Aging Research.
authors.forename: Prudence R
authors.initials: PR
authors.lastname: Carr
authors.affiliation: Divisions of Clinical Epidemiology and Aging Research.
authors.forename: Lina
authors.initials: L
authors.lastname: Jansen
authors.affiliation: Divisions of Clinical Epidemiology and Aging Research.
authors.forename: Viola
authors.initials: V
authors.lastname: Walter
authors.affiliation: Departments of Applied Tumor Biology and.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kloor
authors.affiliation: Unit of Molecular Tumor Pathology; and Pathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany; and.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Roth
authors.affiliation: Institute of Pathology, Charité University Medicine, Berlin, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Bläker
authors.affiliation: Cancer Epidemiology, and.
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang-Claude
authors.affiliation: Divisions of Clinical Epidemiology and Aging Research, Preventive Oncology; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany;
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
authors.affiliation: Divisions of Clinical Epidemiology and Aging Research, m.hoffmeister@dkfz.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoffmeister
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000235:genetics / Q000401:mortality*; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008460:Meat; D008461:Meat Products; D008875:Middle Aged; D009154:Mutation; D009364:Neoplasm Recurrence, Local; D015596:Nutrition Assessment; D011379:Prognosis; D016016:Proportional Hazards Models; D016283:Proto-Oncogene Proteins p21(ras) / Q000235:genetics; D000069466:Red Meat; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis
chemical_list: C117307:KRAS protein, human; D016283:Proto-Oncogene Proteins p21(ras)
keywords: colorectal cancer; molecular subtypes; mortality; red and processed meat; survival