Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Cancer. 2021 Mar 1;127(5):720-728. doi: 10.1002/cncr.33182. Epub 2021 Jan 7.
The Mediterranean diet (MD) may be beneficial for men with localized prostate cancer (PCa) on active surveillance (AS) because of its anti-inflammatory, antilipidemic, and chemopreventive properties. This study prospectively investigated adherence to the MD with Gleason score progression and explored associations by diabetes status, statin use, and other factors.
Men with newly diagnosed PCa on an AS protocol (n = 410) completed a baseline food frequency questionnaire, and the MD score was calculated across 9 energy-adjusted food groups. Cox proportional hazards models were fit to evaluate multivariable-adjusted associations of the MD score with progression-free survival; progression was defined as an increase in the Gleason grade group (GG) score over a biennial monitoring regimen.
In this cohort, 15% of the men were diabetic, 44% of the men used statins, and 76 men progressed (median follow-up, 36 months). After adjustments for clinical factors, higher adherence to the MD was associated with a lower risk of GG progression among all men (hazard ratio [HR] per 1-unit increase in MD score, 0.88; 95% confidence interval [CI], 0.77-1.01), non-White men (HR per 1-unit increase in MD score, 0.64; 95% CI, 0.45-0.92; P for interaction = .07), and men without diabetes (HR per 1-unit increase in MD score, 0.82; 95% CI, 0.71-0.96; P for interaction = .03). When joint effects of the MD score and statin use were examined, a similar risk reduction was observed among men with high MD scores who did not use statins in comparison with men with low/moderate MD scores with no statin use.
The MD is associated with a lower risk of GG progression in men on AS, and this is consistent with prior reports about the MD and reduced cancer morbidity and mortality.
地中海饮食 (Mediterranean diet, MD) 具有抗炎、抗脂质和化学预防特性，可能对接受主动监测 (active surveillance, AS) 的局限性前列腺癌 (prostate cancer, PCa) 男性有益。本研究前瞻性地调查了 MD 与 Gleason 评分进展的一致性，并探讨了糖尿病状态、他汀类药物使用和其他因素的相关性。
在 AS 方案中诊断出新发 PCa 的男性 (n=410) 完成了基线食物频率问卷，通过 9 种能量调整后的食物组计算 MD 评分。采用 Cox 比例风险模型评估 MD 评分与无进展生存期的多变量调整关联；进展定义为在两年监测方案中 Gleason 分级组 (Gleason grade group, GG) 评分增加。
在该队列中，15%的男性患有糖尿病，44%的男性使用他汀类药物，76 名男性进展 (中位随访时间 36 个月)。在调整临床因素后，MD 评分越高，所有男性 GG 进展的风险越低 (MD 评分每增加 1 单位，风险比 [hazard ratio, HR]，0.88；95%置信区间 [confidence interval, CI]，0.77-1.01)，非白种人男性 (MD 评分每增加 1 单位，HR，0.64；95%CI，0.45-0.92；P 交互作用=0.07)，以及无糖尿病的男性 (MD 评分每增加 1 单位，HR，0.82；95%CI，0.71-0.96；P 交互作用=0.03)。当同时检验 MD 评分和他汀类药物使用的联合效应时，与低/中 MD 评分且未使用他汀类药物的男性相比，不使用他汀类药物的高 MD 评分男性的风险降低幅度相似。
MD 与 AS 男性 GG 进展风险降低相关，这与 MD 与降低癌症发病率和死亡率的先前报道一致。
