Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
Department of Pediatric Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
BMC Cancer. 2020 Apr 6;20(1):287. doi: 10.1186/s12885-020-06767-8.
The effects of dietary factors on prognosis of esophageal cancer remain unclear. This systematic review and meta-analysis aimed to assess the association between dietary intake and the risk of mortality among patients with esophageal cancer.
Six electronic databases (PubMed, Web of Science, OVID, ProQuest, CNKI and Wanfang) were searched for studies published up to Oct. 2019 that examined the association between dietary intake and all-cause mortality, esophageal cancer-specific mortality and esophageal cancer recurrence. The pooled hazard ratio (HR) with 95% confidence interval (CI) were derived by comparing the highest with the lowest categories of each dietary item and by using random effect models.
A total of 15 cohort studies were included in this study and all reported pre-diagnosis dietary exposure; two focused on dietary folate, 12 on alcohol consumption and three on other dietary components (sugary beverages, phytochemicals and preserved vegetables). When comparing the highest with the lowest categories, dietary folate intake was associated with a reduced risk of esophageal cancer-specific mortality in patients with esophageal squamous cell carcinoma (HR: 0.41, 95% CI: 0.25-0.69), with low heterogeneity (I = 0%, P = 0.788). When comparing the highest with the lowest categories of alcohol consumption, alcohol consumption was associated with an increased risk of all-cause mortality in patients with esophageal squamous cell carcinoma (HR: 1.29, 95% CI: 1.07-1.55; heterogeneity: I = 53%, P = 0.030), but this increased risk was not significant in patients with esophageal adenocarcinoma (HR = 1.05, 95% CI: 0.84-1.32).
This review with pre-diagnostic dietary exposure showed that dietary folate intake was associated with a reduced risk of mortality of esophageal squamous cell carcinoma, whereas alcohol consumption was associated with an increased risk. More studies are needed to investigate effect of dietary factors, especially post-diagnosis dietary consumption, on esophageal cancer prognosis.
饮食因素对食管癌预后的影响仍不清楚。本系统评价和荟萃分析旨在评估饮食摄入与食管癌患者死亡风险之间的关系。
检索了截至 2019 年 10 月的 6 个电子数据库（PubMed、Web of Science、OVID、ProQuest、CNKI 和万方），以评估饮食摄入与全因死亡率、食管癌特异性死亡率和食管癌复发之间关系的研究。通过比较每个饮食项目的最高和最低类别，使用随机效应模型得出合并的风险比（HR）及其 95%置信区间（CI）。
共有 15 项队列研究纳入本研究，所有研究均报告了诊断前的饮食暴露情况；其中 2 项研究关注饮食叶酸，12 项研究关注饮酒，3 项研究关注其他饮食成分（含糖饮料、植物化学物质和腌制蔬菜）。当比较最高和最低类别时，饮食叶酸摄入与食管鳞癌患者的食管癌特异性死亡率降低相关（HR：0.41，95%CI：0.25-0.69），异质性低（I=0%，P=0.788）。当比较饮酒的最高和最低类别时，饮酒与食管鳞癌患者的全因死亡率增加相关（HR：1.29，95%CI：1.07-1.55；异质性：I=53%，P=0.030），但在食管腺癌患者中这种增加的风险并不显著（HR=1.05，95%CI：0.84-1.32）。
本研究显示，诊断前饮食摄入中叶酸与食管鳞癌患者死亡率降低相关，而饮酒与死亡率增加相关。需要更多的研究来调查饮食因素（特别是诊断后饮食摄入）对食管癌预后的影响。
