Meyerhardt Jeffrey A, Niedzwiecki Donna, Hollis Donna, Saltz Leonard B, Hu Frank B, Mayer Robert J, Nelson Heidi, Whittom Renaud, Hantel Alexander, Thomas James, Fuchs Charles S
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
JAMA. 2007 Aug 15;298(7):754-64. doi: 10.1001/jama.298.7.754.
Dietary factors have been associated with the risk of developing colon cancer but the influence of diet on patients with established disease is unknown.
To determine the association of dietary patterns with cancer recurrences and mortality of colon cancer survivors.
DESIGN, SETTING, AND PATIENTS: Prospective observational study of 1009 patients with stage III colon cancer who were enrolled in a randomized adjuvant chemotherapy trial (CALGB 89803) between April 1999 and May 2001. Patients reported on dietary intake using a semiquantitative food frequency questionnaire during and 6 months after adjuvant chemotherapy. We identified 2 major dietary patterns, prudent and Western, by factor analysis. The prudent pattern was characterized by high intakes of fruits and vegetables, poultry, and fish; the Western pattern was characterized by high intakes of meat, fat, refined grains, and dessert. Patients were followed up for cancer recurrence or death.
Disease-free survival, recurrence-free survival, and overall survival by dietary pattern.
During a median follow-up of 5.3 years for the overall cohort, 324 patients had cancer recurrence, 223 patients died with cancer recurrence, and 28 died without documented cancer recurrence. A higher intake of a Western dietary pattern after cancer diagnosis was associated with a significantly worse disease-free survival (colon cancer recurrences or death). Compared with patients in the lowest quintile of Western dietary pattern, those in the highest quintile experienced an adjusted hazard ratio (AHR) for disease-free survival of 3.25 (95% confidence interval [CI], 2.04-5.19; P for trend <.001). The Western dietary pattern was associated with a similar detriment in recurrence-free survival (AHR, 2.85; 95% CI, 1.75-4.63) and overall survival (AHR, 2.32; 95% CI, 1.36-3.96]), comparing highest to lowest quintiles (both with P for trend <.001). The reduction in disease-free survival with a Western dietary pattern was not significantly modified by sex, age, nodal stage, body mass index, physical activity level, baseline performance status, or treatment group. In contrast, the prudent dietary pattern was not significantly associated with cancer recurrence or mortality.
Higher intake of a Western dietary pattern may be associated with a higher risk of recurrence and mortality among patients with stage III colon cancer treated with surgery and adjuvant chemotherapy. Further studies are needed to delineate which components of such a diet show the strongest association.
饮食因素与结肠癌的发病风险相关，但饮食对已确诊疾病患者的影响尚不清楚。
确定饮食模式与结肠癌幸存者癌症复发及死亡率之间的关联。
设计、地点和患者：对1009例III期结肠癌患者进行前瞻性观察研究，这些患者于1999年4月至2001年5月参加了一项随机辅助化疗试验（CALGB 89803）。患者在辅助化疗期间及化疗后6个月使用半定量食物频率问卷报告饮食摄入量。我们通过因子分析确定了两种主要饮食模式，即谨慎型和西方型。谨慎型模式的特点是水果、蔬菜、家禽和鱼类摄入量高；西方型模式的特点是肉类、脂肪、精制谷物和甜点摄入量高。对患者进行癌症复发或死亡随访。
按饮食模式划分的无病生存期、无复发生存期和总生存期。
在整个队列中位随访5.3年期间，324例患者出现癌症复发，223例患者因癌症复发死亡，28例患者未记录到癌症复发而死亡。癌症诊断后西方饮食模式摄入量较高与无病生存期（结肠癌复发或死亡）显著较差相关。与西方饮食模式最低五分位数的患者相比，最高五分位数的患者无病生存期的调整风险比（AHR）为3.25（9 [5%置信区间（CI），2.04 - 5.19；趋势P <.001）。西方饮食模式与无复发生存期（AHR，2.85；95% CI，1.75 - 4.63）和总生存期（AHR，2.32；95% CI，1.36 - 3.96]）的类似损害相关，最高与最低五分位数相比（趋势P均 <.001）。西方饮食模式导致的无病生存期降低在性别、年龄、淋巴结分期、体重指数、身体活动水平、基线表现状态或治疗组方面未得到显著改变。相比之下，谨慎饮食模式与癌症复发或死亡率无显著关联。
在接受手术和辅助化疗的III期结肠癌患者中，西方饮食模式摄入量较高可能与复发和死亡风险较高相关。需要进一步研究来确定这种饮食的哪些成分显示出最强的关联。
