Identification of lifestyle behaviors associated with recurrence and survival in colorectal cancer patients using random survival forests

Moniek van Zutphen, Fränzel J.B. van Duijnhoven, Evertine Wesselink, Ruud W.M. Schrauwen, Ewout A. Kouwenhoven, Henk K. van Halteren, Johannes H.W. de Wilt, Renate M. Winkels, Dieuwertje E. Kok, Hendriek C. Boshuizen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)


Current lifestyle recommendations for cancer survivors are the same as those for the general public to decrease their risk of cancer. However, it is unclear which lifestyle behaviors are most important for prognosis. We aimed to identify which lifestyle behaviors were most important regarding colorectal cancer (CRC) recurrence and all-cause mortality with a data-driven method. The study consisted of 1180 newly diagnosed stage I–III CRC patients from a prospective cohort study. Lifestyle behaviors included in the current recommendations, as well as additional lifestyle behaviors related to diet, physical activity, adiposity, alcohol use, and smoking were assessed six months after diagnosis. These behaviors were simultaneously analyzed as potential predictors of recurrence or all-cause mortality with Random Survival Forests (RSFs). We observed 148 recurrences during 2.6-year median follow-up and 152 deaths during 4.8-year median follow-up. Higher intakes of sugary drinks were associated with increased recurrence risk. For all-cause mortality, fruit and vegetable, liquid fat and oil, and animal protein intake were identified as the most important lifestyle behaviors. These behaviors showed non-linear associations with all-cause mortality. Our exploratory RSF findings give new ideas on potential associations between certain lifestyle behaviors and CRC prognosis that still need to be confirmed in other cohorts of CRC survivors.

Original languageEnglish
Article number2442
Issue number10
Publication statusPublished - 18 May 2021


  • Colorectal cancer
  • Lifestyle
  • Random survival forests
  • Recurrence
  • Survival


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