Dr Char on the Association Between the Empirical Dietary Inflammatory Pattern and Survival Outcomes in Stage III Colon Cancer

"For overall survival, however, we did find a significant difference. Patients in the highest EDIP quintile—those who consumed the top 20% most inflammatory diets—had an 87% higher risk of death [compared with] those in the lowest quintile, who consumed the least inflammatory diets."

Sara Char, MD, presented findings from an exploratory analysis of phase 3 CALGB/SWOG 80702 (NCT01150045), evaluating the association between the empirical dietary inflammatory pattern (EDIP) and survival outcomes in patients with stage III colon cancer. The study evaluated the addition of celecoxib vs placebo to standard adjuvant therapy in this patient population.

The EDIP analysis aimed to determine whether pro-inflammatory dietary patterns were associated with disease-free survival (DFS) and overall survival (OS) outcomes in a prospective cohort of patients enrolled on the phase 3 trial.

CALGB/SWOG 80702 investigated the effect of 3 vs 6 months of adjuvant FOLFOX (leucovorin, fluorouracil, and oxaliplatin) with or without the COX-2 inhibitor celecoxib in patients with resected stage III colon cancer. Dietary data were collected from participants using validated food frequency questionnaires and used to calculate EDIP scores, which estimate the inflammatory potential of a patient’s habitual diet. Patients were stratified into quintiles based on their EDIP scores, with higher quintiles reflecting more pro-inflammatory dietary patterns.

In multivariable-adjusted models, EDIP scores were not significantly associated with DFS outcomes, the study’s primary end point. However, analysis of OS demonstrated a statistically significant association between higher EDIP scores and worse survival. Specifically, patients in the highest EDIP quintile—those consuming the most pro-inflammatory diets—had an 87% increased risk of death compared with those in the lowest quintile (HR, 1.87), after adjusting for potential confounders.

Subgroup analyses were performed to evaluate whether concomitant use of anti-inflammatory agents, including aspirin and celecoxib, modified the association between dietary inflammation and OS. The observed association between higher EDIP scores and increased mortality remained consistent across these subgroups, suggesting that the pro-inflammatory impact of diet on survival was independent of pharmacologic anti-inflammatory use.