Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute, New Brunswick, New Jersey.
JAMA Netw Open. 2024 Oct 1;7(10):e2440279. doi: 10.1001/jamanetworkopen.2024.40279.
Ovarian cancer survival among Black women is the lowest across all racial and ethnic groups. Poor dietary quality also disproportionately affects Black populations, but its association with ovarian cancer survival in this population remains largely unknown.
To examine associations between dietary patterns and survival among Black women diagnosed with epithelial ovarian cancer (EOC).
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted among self-identified Black women aged 20 to 79 years newly diagnosed with histologically confirmed EOC in the African American Cancer Epidemiology Study (AACES) between December 2010 and December 2015, with follow-up until October 2022. AACES is a population-based study of ovarian cancer risk and survival among Black women in 11 US regions. Data were analyzed from March 2023 to June 2024.
Dietary patterns were assessed by the Healthy Eating Index-2020 (HEI-2020) and Alternative Healthy Eating Index-2010 (AHEI-2010), with scores calculated based on dietary intake in the year prior to diagnosis and collected via the validated Block 2005 Food Frequency Questionnaire. Higher scores indicate better dietary quality.
Hazard ratios (HRs) and 95% CIs were estimated from multivariable Cox models for the association between adherence to dietary recommendations and overall mortality among all participants and those with high-grade serous ovarian cancer (HGSOC).
Among 483 Black women with EOC (mean [SD] age, 58.1 [10.5] years), 310 deaths were recorded during a median (IQR) follow-up of 4.3 (2.0-8.2) years. No association of dietary patterns with mortality was found among women with EOC overall. However, among 325 women with HGSOC, better adherence to HEI-2020 was associated with decreased mortality in later quartiles compared with the first quartile (HR, 0.63; 95% CI, 0.44-0.92 for quartile 2; HR, 0.67; 95% CI, 0.46-0.97 for quartile 3; HR, 0.63; 95% CI, 0.44-0.91 for quartile 4 ). Similar results were observed with AHEI-2010 among women with HGSOC for the second (HR, 0.62; 95% CI, 0.43-0.89) and fourth (HR, 0.67; 95% CI, 0.45-0.98) quartiles compared with quartile 1.
In this study, women with moderate and high prediagnosis dietary quality had significantly lower mortality rates from HGSOC compared with women with the lowest prediagnosis dietary quality. These findings suggest that even moderate adherence to dietary guidelines prior to diagnosis may be associated with improved survival among Black women with HGSOC, the most lethal form of ovarian cancer.
在所有种族和族裔群体中，黑人女性的卵巢癌存活率最低。不良的饮食质量也不成比例地影响黑人人口，但它与该人群中卵巢癌存活率的关系在很大程度上仍然未知。
研究饮食模式与黑人女性确诊为上皮性卵巢癌（EOC）后的生存之间的关联。
设计、地点和参与者：这项前瞻性队列研究是在非洲裔美国癌症流行病学研究（AACES）中进行的，该研究纳入了 2010 年 12 月至 2015 年 12 月期间新确诊为组织学证实的 EOC 的自认为是黑人的年龄在 20 至 79 岁的女性，随访至 2022 年 10 月。AACES 是一项针对美国 11 个地区黑人女性卵巢癌风险和生存的基于人群的研究。数据于 2023 年 3 月至 2024 年 6 月进行分析。
饮食模式通过健康饮食指数-2020（HEI-2020）和替代健康饮食指数-2010（AHEI-2010）进行评估，分数根据诊断前一年的饮食摄入量和通过验证的 Block 2005 食物频率问卷进行收集。较高的分数表示更好的饮食质量。
多变量 Cox 模型用于估计所有参与者和高级别浆液性卵巢癌（HGSOC）患者中，饮食建议的依从性与全因死亡率之间的关联的风险比（HR）和 95%置信区间（CI）。
在 483 名患有 EOC 的黑人女性中（平均[标准差]年龄，58.1[10.5]岁），中位（IQR）随访 4.3（2.0-8.2）年后记录了 310 例死亡。在总体 EOC 女性中，饮食模式与死亡率之间没有关联。然而，在 325 名患有 HGSOC 的女性中，与第一四分位相比，HEI-2020 更好的依从性与死亡率降低相关（四分位 2 的 HR，0.63；95%CI，0.44-0.92；四分位 3 的 HR，0.67；95%CI，0.46-0.97；四分位 4 的 HR，0.63；95%CI，0.44-0.91）。在患有 HGSOC 的女性中，使用 AHEI-2010 也观察到了类似的结果，第二（HR，0.62；95%CI，0.43-0.89）和第四（HR，0.67；95%CI，0.45-0.98）四分位与四分位 1 相比。
在这项研究中，与最低预测饮食质量的女性相比，饮食质量中等和较高的女性 HGSOC 的死亡率明显降低。这些发现表明，即使在诊断前对饮食指南有适度的依从性，也可能与黑人女性 HGSOC 的生存改善相关，HGSOC 是卵巢癌最致命的形式。
