饮食模式和主要食物组对癌症幸存者死亡率和复发率的影响：当前流行病学文献的系统综述
Impact of dietary patterns and the main food groups on mortality and recurrence in cancer survivors: a systematic review of current epidemiological literature.
作者信息
Jochems Sylvia H J, Van Osch Frits H M, Bryan Richard T, Wesselius Anke, van Schooten Frederik J, Cheng Kar Keung, Zeegers Maurice P
机构信息
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
出版信息
BMJ Open. 2018 Feb 19;8(2):e014530. doi: 10.1136/bmjopen-2016-014530.
OBJECTIVE
To determine whether there is an association between dietary patterns/indices and foods from the main food groups (highest vs lowest intakes) prior to or after cancer diagnosis and mortality and cancer recurrence in cancer survivors.
PARTICIPANTS
Survivors of common cancers with a 10-year survival rate of ≥50%: bladder, bowel, breast, cervical, kidney, laryngeal, prostate, testicular, uterine cancer, malignant melanoma and (non-)Hodgkin's lymphoma.
OUTCOME MEASURES
Mortality (overall, cancer-specific, from other causes) and cancer recurrence.
INFORMATION SOURCES
PubMed, Embase and the Cochrane Library were searched from inception to April 2017. Additional studies were identified by searching reference lists. Two authors independently screened titles and abstracts, assessed study quality and extracted the data.
RESULTS
A total of 38 studies were included. The risk of bias was rated low for the included randomised controlled trials (RCTs) and moderate for the cohort studies. The quality of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach and was rated moderate (RCTs), and (very)low (cohort studies). Reducing the amount of fat after diagnosis appears to decrease the risk of breast cancer recurrence. Adherence to a high-quality diet and prudent diet after diagnosis appears to decrease the risk of death from other causes (and overall mortality for high-quality diet) in breast cancer survivors. Adherence to a Western diet, before and after diagnosis, appears to increase the risk of overall mortality and death from other causes among breast cancer survivors. Evidence from studies among other cancer survivors was too limited or could not be identified.
CONCLUSION
For many cancer survivors, there is little evidence to date to indicate that particular dietary behaviours influence outcomes with regard to recurrence and mortality. Notwithstanding, limited evidence suggests that a low-fat diet, a high-quality diet and a prudent diet are beneficial for breast cancer survivors, while a Western diet is detrimental for breast cancer survivors.
目的
确定癌症诊断前后的饮食模式/指数与主要食物组的食物（摄入量最高与最低）之间是否存在关联，以及对癌症幸存者的死亡率和癌症复发情况的影响。
参与者
10年生存率≥50%的常见癌症幸存者：膀胱癌、肠癌、乳腺癌、宫颈癌、肾癌、喉癌、前列腺癌、睾丸癌、子宫癌、恶性黑色素瘤以及（非）霍奇金淋巴瘤。
观察指标
死亡率（总体、癌症特异性、其他原因导致的）和癌症复发情况。
信息来源
检索了从创刊至2017年4月的PubMed、Embase和Cochrane图书馆。通过检索参考文献列表确定了其他研究。两位作者独立筛选标题和摘要，评估研究质量并提取数据。
结果
共纳入38项研究。纳入的随机对照试验（RCT）的偏倚风险被评为低，队列研究的偏倚风险被评为中等。采用推荐分级、评估、制定与评价（GRADE）方法评估证据质量，RCT为中等，队列研究为（非常）低。诊断后减少脂肪摄入量似乎可降低乳腺癌复发风险。诊断后坚持高质量饮食和谨慎饮食似乎可降低乳腺癌幸存者因其他原因导致的死亡风险（以及高质量饮食的总体死亡率）。诊断前后坚持西方饮食似乎会增加乳腺癌幸存者的总体死亡率和因其他原因导致的死亡风险。其他癌症幸存者的研究证据非常有限或未找到。
结论
对于许多癌症幸存者而言，目前几乎没有证据表明特定的饮食行为会影响复发和死亡率。尽管如此，有限的证据表明，低脂饮食、高质量饮食和谨慎饮食对乳腺癌幸存者有益，而西方饮食对乳腺癌幸存者有害。
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