Dietary factors and risk of mortality among patients with esophageal cancer: a systematic review

Abstract

Background 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. Methods 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. Results 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 (I2 = 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: I2 = 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). Conclusions 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.

Clinical and Lifestyle-Related Prognostic Indicators among Esophageal Adenocarcinoma Patients Receiving Treatment at a Comprehensive Cancer Center

“…In exploratory analyses, we found that consumption of over three servings of broccoli or carrots, and higher total dietary fiber intake, was associated with reduced risk of all-cause mortality among patients with localized/regional EAC. Similar to a small number of prior studies, we did not find evidence of survival associations with dietary macronutrients such as sugar and carbohydrates [ 26 , 53 , 54 ]. We also observed improved overall survival with increasing frequency of intake of total vegetables, and among patients with high (versus low) total dietary fiber.…”

“…By contrast, one recent study reported reduced survival for each 20 pack-year increase in smoking intensity [ 17 ], highlighting inconsistencies in current knowledge. Diet, another important modifiable lifestyle factor, has not been intensively investigated in relation to EAC outcomes [ 26 ]. With respect to medications, no survival associations have been identified for pre-diagnostic aspirin/NSAID use [ 12 , 19 ], but post-diagnostic use of statins was linked to improved survival [ 27 , 28 ].…”

Even-Chain UFA Pattern, n-3 Long-Chain PUFA Pattern and Risk of Esophageal Squamous Cell Carcinoma in Southeast of China

“…The role of alcohol use in the etiology of carcinoma of the esophagus is well established [47] . Lots of studies conducted in Kenyan [48] , Japan [49] , have provided further evidence of the close and independent role of alcohol in the etiology of ESCC.…”

Heterogeneity Analysis of Esophageal Squamous Cell Carcinoma in Cell Lines, Tumor Tissues and Patient-Derived Xenografts

“…For instance, several nations report high incidence rates of ESCC despite prohibition of alcohol consumption [32]. An integrative analysis of 15 cohort studies concluded that supplementing the diet with folate could potentially reduce the risk of ESCC mortality, while alcohol consumption may increase the risk [33]. Although studies have attempted to determine genetic, environmental, and dietary contributions to ESCC carcinogenesis in areas with high-rate ESCC incidences [34,35], the exact risk factors and etiology have not been thoroughly elucidated.…”