| Objective: In recent years,various diet quality scores of diverse diet habits and different diet scoring systems were established,which with great discrepancies between each other.Owing to the limited studies and controversial results,the link between pre-diagnosis diet quality and survival in Ovarian Cancer(OC)patients is unclear.This study intends to explore the association between pre-diagnosis diet quality and risk of all-cause mortality in patients with OC based on three different diet quality scores.Methods: This study based on Ovarian Cancer Follow-Up Study(OOPS).A total of796 OC patients were recruited from the gynecological oncology ward at Shengjing Hospital of China Medical University between January 2015 and March 2021.Information was obtained by questionnaire,physical examination and medical data based on the information system in Shengjing Hospital,which included baseline information,clinical characteristics,environmental factors,lifestyles and so on.Both passive and active modes can acquire outcomes.We selected t-test,rank sum test or Chi-square test to compare the differences in survival outcomes(survival and death)among patients with OC.Three diet quality scores,including Chinese Healthy Eating Index(CHEI),Dietary Balance Index(DBI),and Chinese Food Pagoda Score(CFPS),were calculated using a validated 111-item food frequency questionnaire.Subsequently,Cox Proportional Hazard regression models were used to estimate hazard ratios(HR)and 95% Confidence Intervals(CI)to explore the association between diet quality and survival in patients with OC under different diet quality scoring systems before diagnosis.Also adjust for potential confounding factors.According to age at diagnosis,menopausal status,body mass index,histological type,Federation of Gynecology and Obstetrics(FIGO)stage,residual lesions,and immunohistochemical indicators,subgroup analysis and interaction analysis were performed to find the sources of heterogeneity.Results: As of March 31,2021,a total of 130 deaths were observed with a median follow-up time of 37.17 months(Quartile: 24.73-50.17 months).The results showed that overall survival(OS)of patients in the group with the highest CHEI score was better than those in the group with the lowest CHEI score,with HR(95%CI)of 0.51(0.32,0.81).A significant dose-response relationship was observed between CHEI and OS.With each additional standard deviation(SD)of CHEI score,the risk of death in OC patients decreased by 20%,and the corresponding HR(95%CI)were 0.80(0.66,0.96).However,no evidence of significant associations of DBI with OC survival was observed in all adjustment models.Comparing the adherence to the Chinese Food Pagoda in different evaluation groups,there was no beneficial effect on OC survival in patients with higher adherence.In subgroup analysis,CHEI was significantly associated with survival of patients with OC in most subgroups.However,DBI score was only found to be correlated with OS in no residual lesions,Vimentin positive and WT-1 negative expression OC patients.The results of the interaction showed significant additive interactions between LBS and WT-1,CHEI and menopausal status and WT-1,CFPS and WT-1.All diet quality scores(CHEI,CFPS,DBI)and WT-1showed multiplicative interaction.The results of sensitivity analysis are consistent with the main analysis.Notably,after excluding patients who died within one year of enrollment,we observed that a high Diet Quality Distance before diagnosis was associated with increased all-cause mortality in OC patients.Conclusion: Pre-diagnosis high CHEI score was a protective factor for survival in patients with OC,while the other two diet quality scores(DBI and CFPS)was not associated with OC survival. |
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