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Heterogeneity of Colorectal Cancer Risk Factors by Anatomical Subsite in 10 European Countries: A Multinational Cohort Study
Open accessAbstract
BACKGROUND & AIMS: Colorectal cancer located at different anatomical subsites may have distinct etiologies and risk factors. Previous studies that have examined this hypothesis have yielded inconsistent results, possibly because most studies have been of insufficient size to identify heterogeneous associations with precision. METHODS: In the European Prospective Investigation into Cancer and Nutrition study, we used multivariable joint Cox proportional hazards models, which accounted for tumors at different anatomical sites (proximal colon, distal colon, and rectum) as competing risks, to examine the relationships between 14 established/suspected lifestyle, anthropometric, and reproductive/menstrual risk factors with colorectal cancer risk. Heterogeneity across sites was tested using Wald tests. RESULTS: After a median of 14.9 years of follow-up of 521,330 men and women, 6291 colorectal cancer cases occurred. Physical activity was related inversely to proximal colon and distal colon cancer, but not to rectal cancer (P heterogeneity = .03). Height was associated positively with proximal and distal colon cancer only, but not rectal cancer (P heterogeneity = .0001). For men, but not women, heterogeneous relationships were observed for body mass index (P heterogeneity = .008) and waist circumference (P heterogeneity = .03), with weaker positive associations found for rectal cancer, compared with proximal and distal colon cancer. Current smoking was associated with a greater risk of rectal and proximal colon cancer, but not distal colon cancer (P heterogeneity = .05). No heterogeneity by anatomical site was found for alcohol consumption, diabetes, nonsteroidal anti-inflammatory drug use, and reproductive/menstrual factors. CONCLUSIONS: The relationships between physical activity, anthropometry, and smoking with colorectal cancer risk differed by subsite, supporting the hypothesis that tumors in different anatomical regions may have distinct etiologies.
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Partial residuals for the proportional hazards regression model
SCHOENFELD, D. (1982) · Biometrika · doi:10.1093/biomet/69.1.239 · Cited by 3,111
Riboli, E., Hunt, K., Slimani, N., Ferrari, P., Norat, T., Fahey, M., Charrondière, U., Hémon, B., Casagrande, C., Vignat, J., et al. (2002) · Public Health Nutrition · doi:10.1079/phn2002394 · Cited by 1,866
Self-citationAssociation of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults
Moore, S. C., Lee, I.-M., Weiderpass, E., Campbell, P. T., Sampson, J. N., Kitahara, C. M., Keadle, S. K., Arem, H., Berrington de Gonzalez, A., Hartge, P., et al. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.1548 · Cited by 1,487
Self-citationPischon, T., Lahmann, P. H., Boeing, H., Friedenreich, C., Norat, T., Tjønneland, A., Halkjaer, J., Overvad, K., Clavel-Chapelon, F., Boutron-Ruault, M.-C., et al. (2006) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djj246 · Cited by 554
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Metadata
- Authors
- Murphy, N., Ward, H. A., Jenab, M., Rothwell, J. A., Boutron-Ruault, M.-C., Carbonnel, F., Kvaskoff, M., Kaaks, R., Kühn, T., Boeing, H., Aleksandrova, K., Weiderpass, E., Skeie, G., Borch, K. B., Tjønneland, A., Kyrø, C., Overvad, K., Dahm, C. C., Jakszyn, P., Sánchez, M.-J., Gil, L., Huerta, J. M., Barricarte, A., Quirós, J. R., Khaw, K.-T., Wareham, N., Bradbury, K. E., Trichopoulou, A., La Vecchia, C., Karakatsani, A., Palli, D., Grioni, S., Tumino, R., Fasanelli, F., Panico, S., Bueno-de-Mesquita, B., Peeters, P. H., Gylling, B., Myte, R., Jirström, K., Berntsson, J., Xue, X., Riboli, E., Cross, A. J., & Gunter, M. J.
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2019-06
- Volume
- 17
- Issue
- 7
- Pages
- 1323-1331.e6
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W2883015258
- Cited by
- 165
- References
- 4
- FWCI
- 6.40
- Type
- journal article
- Language
- en
- Open access
- hybrid
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- Murphy, N., Ward, H. A., Jenab, M., Rothwell, J. A., Boutron-Ruault, M.-C., Carbonnel, F., Kvaskoff, M., Kaaks, R., Kühn, T., Boeing, H., Aleksandrova, K., Weiderpass, E., Skeie, G., Borch, K. B., Tjønneland, A., Kyrø, C., Overvad, K., Dahm, C. C., Jakszyn, P., . . . Gunter, M. J. (2019). Heterogeneity of Colorectal Cancer Risk Factors by Anatomical Subsite in 10 European Countries: A Multinational Cohort Study. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2018.07.030
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
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