Pierce John P
Cancer Prevention and Control Program, MooresUCSD Cancer Center, University of California, SanDiego, La Jolla, California 92093-0901, USA.
Curr Opin Obstet Gynecol. 2009 Feb;21(1):86-91. doi: 10.1097/gco.0b013e32831da7f2.
To clarify the role of dietary pattern on prognosis in breast cancer survivors.
Observational trials show mixed results that do not strongly support an independent role for dietary pattern in prognosis. Women's Intervention Nutrition Study and Women's Healthy Eating and Living (WHEL) are two large randomized controlled trials that address this question. The interventions from both studies achieved significant reductions in energy from fat, and the WHEL Study achieved large increases in vegetables, fruit and fiber. Women's Intervention Nutrition Study examined postmenopausal women only and reported a not-quite-significant improved prognosis for women in the intervention group, with the benefit focused on ipsilateral localized recurrences, but little improvement in the more important distal recurrences. This review considers only WHEL postmenopausal women to aid a direct comparison with Women's Intervention Nutrition Study. The WHEL Study reported a convincing lack of association between diet and prognosis. However, a secondary analysis suggests that the dietary intervention reduced distal recurrences among the subgroup without hot flashes at baseline.
There is no convincing evidence that changing dietary pattern following breast cancer diagnosis will improve prognosis for most women with early stage breast cancer. However, it would appear to be important for some subgroups. Further investigation of mechanisms for such selective action is needed.
阐明饮食模式在乳腺癌幸存者预后中的作用。
观察性试验结果不一，并未有力支持饮食模式在预后方面具有独立作用。女性干预营养研究和女性健康饮食与生活（WHEL）研究是两项针对该问题的大型随机对照试验。两项研究的干预措施均使脂肪能量显著降低，且WHEL研究使蔬菜、水果和纤维的摄入量大幅增加。女性干预营养研究仅纳入了绝经后女性，报告称干预组女性的预后有不太显著的改善，益处主要集中在同侧局部复发方面，但在更重要的远处复发方面改善甚微。本综述仅考虑WHEL研究中的绝经后女性，以便与女性干预营养研究进行直接比较。WHEL研究报告称饮食与预后之间不存在令人信服的关联。然而，一项二次分析表明，饮食干预降低了基线时无潮热症状亚组的远处复发率。
没有令人信服的证据表明，乳腺癌诊断后改变饮食模式会改善大多数早期乳腺癌女性的预后。然而，对某些亚组而言似乎很重要。需要进一步研究这种选择性作用的机制。
