Association of family history and survival in patients with colorectal cancer: a pooled analysis of eight epidemiologic studies.

Dawn Q Chong,Emily White,Polly A Newcomb,Ulrike Peters,Wen‐Yi Huang,Tabitha Harrison,Sonja I Berndt,Barbara L Banbury,Amanda I Phipps,Martha L Slattery,Jonathan Kocarnik,Xinwei Hua,Andrew T Chan,John D Potter,Peter T Campbell

doi:10.1002/cam4.1470

Abstract

A family history of colorectal cancer (CRC) in first‐degree relatives (FDRs) increases the risk of CRC. However, the influence of family history on survival among CRC patients remains unclear. We conducted a pooled analysis of survival in 5010 incident CRC cases. Cox proportional hazards models were used to estimate the association of family history with overall survival (OS) and CRC‐specific survival (CSS). We also assessed the impact of the number of affected FDRs and age at CRC diagnosis in the affected FDRs on survival. Among CRC cases, 819 (16%) patients reported a family history of CRC. There were 1580 total deaths over a median follow‐up of 4.6 years, of which 1046 (66%) deaths were due to CRC. Having a family history of CRC was not associated with OS [hazard ratio (HR), 1.03; 95% confidence interval (CI), 0.89–1.19] or CSS (HR, 1.13; 95% CI, 0.95–1.36)]. There were no associations between the number of affected relatives or age at CRC diagnosis of the affected relative with survival (all P trend > 0.05). However, a family history of CRC did confer worse CSS in patients diagnosed with distal colon cancer (HR, 1.45, 95% CI, 1.03–2.04). A family history of CRC was generally not associated with survival after CRC diagnosis. However, having a family history of CRC was associated with worse CRC prognosis in individuals with distal colon cancer, suggesting a possible genetic predisposition with distinct pathogenic mechanism that may lead to worse survival in this group.

Highlights

Colorectal cancer (CRC) is the third most common cancer diagnosed in both men and women in the United States
Overall, having a family history of CRC was not associated with overall survival (OS) (HR, 1.03; 95% confidence interval (CI), 0.89–1.19) or CRC-specific survival (CSS) (HR, 1.13; 95% CI, 0.95–1.36) after adjusting for age at diagnosis, sex, body mass index (BMI), smoking status, regular use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), history of endoscopy screening, and stratified by tumor location, stage at diagnosis, and study site (Table 2)
Compared to patients without a family history of CRC, the multivariate hazard ratio (HR) for OS were 1.00 for individuals with 1 affected first-degree relatives (FDRs) and 0.92 for individuals with ≥2 affected FDRs

Summary

Introduction

Colorectal cancer (CRC) is the third most common cancer diagnosed in both men and women in the United States. Penetrant hereditary CRC syndromes, including familial adenomatous polyposis (FAP) and Lynch syndrome account for less than 5% of the familial risk [9, 10] Beyond these rare CRC syndromes that have been associated with favorable prognosis [11, 12], the effect of general family history on CRC survival remains inconsistent [6, 13,14,15,16,17,18,19,20,21,22,23,24,25].

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