title: Prediagnostic Calcium Intake and Lung Cancer Survival: A Pooled Analysis of 12 Cohort Studies.
abstract: Background:Lung cancer is the leading cause of cancer death. Little is known about whether prediagnostic nutritional factors may affect survival. We examined the associations of prediagnostic calcium intake from foods and/or supplements with lung cancer survival.Methods:The present analysis included 23,882 incident, primary lung cancer patients from 12 prospective cohort studies. Dietary calcium intake was assessed using food-frequency questionnaires at baseline in each cohort and standardized to caloric intake of 2,000 kcal/d for women and 2,500 kcal/d for men. Stratified, multivariable-adjusted Cox regression was applied to compute hazard ratios (HR) and 95% confidence intervals (CI).Results:The 5-year survival rates were 56%, 21%, and 5.7% for localized, regional, and distant stage lung cancer, respectively. Low prediagnostic dietary calcium intake (<500-600 mg/d, less than half of the recommendation) was associated with a small increase in risk of death compared with recommended calcium intakes (800-1,200 mg/d); HR (95% CI) was 1.07 (1.01-1.13) after adjusting for age, stage, histology, grade, smoking status, pack-years, and other potential prognostic factors. The association between low calcium intake and higher lung cancer mortality was evident primarily among localized/regional stage patients, with HR (95% CI) of 1.15 (1.04-1.27). No association was found for supplemental calcium with survival in the multivariable-adjusted model.Conclusions:This large pooled analysis is the first, to our knowledge, to indicate that low prediagnostic dietary calcium intake may be associated with poorer survival among early-stage lung cancer patients.Impact:This multinational prospective study linked low calcium intake to lung cancer prognosis.Cancer Epidemiol Biomarkers Prev; 26(7); 1060-70. ©2017 AACR.
authors.affiliation: Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Danxia
authors.initials: D
authors.lastname: Yu
authors.affiliation: Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee.|College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.
authors.forename: Yumie
authors.initials: Y
authors.lastname: Takata
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Smith-Warner
authors.affiliation: Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: William
authors.initials: W
authors.lastname: Blot
authors.affiliation: Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
authors.forename: Norie
authors.initials: N
authors.lastname: Sawada
authors.affiliation: Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Emily
authors.initials: E
authors.lastname: White
authors.affiliation: Division of Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Neal
authors.initials: N
authors.lastname: Freedman
authors.affiliation: Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.
authors.forename: Kim
authors.initials: K
authors.lastname: Robien
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Edward
authors.initials: E
authors.lastname: Giovannucci
authors.affiliation: Dana Farber Cancer Institute, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Xuehong
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Yikyung
authors.initials: Y
authors.lastname: Park
authors.affiliation: Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yu-Tang
authors.initials: YT
authors.lastname: Gao
authors.affiliation: Los Angeles Biomedical Research Institute at the Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Rowan T
authors.initials: RT
authors.lastname: Chlebowski
authors.affiliation: HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Langhammer
authors.affiliation: Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Gong
authors.initials: G
authors.lastname: Yang
authors.affiliation: Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.|Gustave Roussy, Villejuif, France.|Human Genetics Foundation, Torino, Italy.|Cancer Council Victoria and University of Melbourne, Australia.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Severi
authors.affiliation: Department of Surgery, Lund University, University Hospital Malmö, Malmö, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Manjer
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, United Kingdom.
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.|Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Division of Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Liao
authors.affiliation: Division of Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Neil
authors.initials: N
authors.lastname: Caporaso
authors.affiliation: HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Steinar
authors.initials: S
authors.lastname: Krokstad
authors.affiliation: HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Kristian
authors.initials: K
authors.lastname: Hveem
authors.affiliation: Division of Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Sinha
authors.affiliation: Division of Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
authors.forename: Regina
authors.initials: R
authors.lastname: Ziegler
authors.affiliation: Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Tsugane
authors.affiliation: Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yong-Bing
authors.initials: YB
authors.lastname: Xiang
authors.affiliation: Genetic Epidemiology Group, International Agency for Research on Cancer, Lyons, France.
authors.forename: Mattias
authors.initials: M
authors.lastname: Johansson
authors.affiliation: Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Wei
authors.initials: W
authors.lastname: Zheng
authors.affiliation: Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, Tennessee. xiao-ou.shu@vanderbilt.edu.
authors.forename: Xiao-Ou
authors.initials: XO
authors.lastname: Shu
mesh_terms: D000368:Aged; D002136:Calcium, Dietary; D004034:Diet Surveys / Q000706:statistics & numerical data; D019587:Dietary Supplements; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D002136:Calcium, Dietary