Farvid Maryam S, Holmes Michelle D, Chen Wendy Y, Rosner Bernard A, Tamimi Rulla M, Willett Walter C, Eliassen A Heather
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Cancer Res. 2020 Nov 15;80(22):5134-5143. doi: 10.1158/0008-5472.CAN-18-3515.
Fruits and vegetables contain many bioactive components that may contribute to improved survival after diagnosis of breast cancer, however, evidence to date is insufficient. We prospectively assessed the associations of postdiagnostic fruit and vegetable consumption with breast cancer-specific and all-cause mortality among 8,927 women with stage I-III breast cancer identified during follow-up of the Nurses' Health Study (NHS; 1980-2010) and NHSII (1991-2011), using a validated food frequency questionnaire completed every 4 years after diagnosis. We prospectively documented 2,521 deaths, including 1,070 from breast cancer through follow-up until 2014 in the NHS and 2015 in the NHSII. Total fruit and vegetable and total vegetable consumption was related to lower all-cause [HR, 0.82; 95% confidence interval (CI), 0.71-0.94; = 0.004, and HR, 0.84; 95% CI, 0.72-0.97; = 0.001, respectively], but not breast cancer-specific mortality. Total fruit consumption was not related to breast cancer-specific or all-cause mortality. Greater intake of green leafy and cruciferous vegetables was associated with lower all-cause mortality. Each 2 servings/week of blueberries was associated with a 25% (HR, 0.75; 95% CI, 0.60-0.94) lower breast cancer-specific and a 17% (HR, 0.83; 95% CI, 0.72-0.96) lower all-cause mortality. In contrast, higher fruit juice consumption was associated with higher breast cancer-specific (HR, 1.33; 95% CI, 1.09-1.63; = 0.002) and all-cause mortality (HR, 1.19; 95% CI, 1.04-1.36; = 0.003). Apple juice largely accounted for these higher risks and orange juice was not associated with risk. Higher postdiagnostic fruit and vegetable consumption among breast cancer survivors was not associated with breast cancer-specific mortality. However, our findings suggest that higher vegetable consumption, particularly green leafy and cruciferous vegetables, was associated with better overall survival among patients with breast cancer. Higher fruit juice consumption, but not orange juice, was associated with poorer breast cancer-specific and all-cause survival. SIGNIFICANCE: A large-scale study shows that high fruit and vegetable consumption may be associated with better overall survival among breast cancer patients, while high fruit juice consumption may be associated with poorer porgnosis.
水果和蔬菜含有许多生物活性成分，可能有助于提高乳腺癌诊断后的生存率，然而，迄今为止的证据并不充分。我们前瞻性地评估了8927名I - III期乳腺癌女性患者在确诊后水果和蔬菜摄入量与乳腺癌特异性死亡率及全因死亡率之间的关联。这些患者来自护士健康研究（NHS；1980 - 2010年）和护士健康研究II（NHSII；1991 - 2011年）的随访队列，通过每4年填写一份经过验证的食物频率问卷来记录确诊后的饮食情况。我们前瞻性地记录了2521例死亡病例，其中包括NHS队列中截至2014年以及NHSII队列中截至2015年的1070例乳腺癌死亡病例。水果和蔬菜的总摄入量以及蔬菜的总摄入量与较低的全因死亡率相关[风险比（HR），0.82；95%置信区间（CI），0.71 - 0.94；P = 0.004，以及HR，0.84；95% CI，0.72 - 0.97；P = 0.001]，但与乳腺癌特异性死亡率无关。水果的总摄入量与乳腺癌特异性死亡率及全因死亡率均无关。绿叶蔬菜和十字花科蔬菜摄入量的增加与较低的全因死亡率相关。每周每增加2份蓝莓摄入量，乳腺癌特异性死亡率降低25%（HR，0.75；95% CI，0.60 - 0.94），全因死亡率降低17%（HR，0.83；95% CI，0.72 - 0.96）。相比之下，较高的果汁摄入量与较高的乳腺癌特异性死亡率（HR，1.33；95% CI，1.09 - 1.63；P = 0.002）及全因死亡率（HR，1.19；95% CI，1.04 - 1.36；P = 0.003）相关。这些较高的风险主要由苹果汁导致，橙汁与风险无关。乳腺癌幸存者确诊后较高的水果和蔬菜摄入量与乳腺癌特异性死亡率无关。然而，我们的研究结果表明，较高的蔬菜摄入量，尤其是绿叶蔬菜和十字花科蔬菜，与乳腺癌患者更好的总体生存率相关。较高的果汁摄入量，但不包括橙汁，与较差的乳腺癌特异性生存率及全因生存率相关。意义：一项大规模研究表明，高水果和蔬菜摄入量可能与乳腺癌患者更好的总体生存率相关，而高果汁摄入量可能与较差的预后相关。
