Prediagnostic Proinflammatory Dietary Potential Is Associated with All-Cause Mortality among African-American Women with High-Grade Serous Ovarian Carcinoma

Abstract

Background Chronic inflammation is associated with ovarian carcinogenesis; yet, the impact of inflammatory-related exposures on outcomes has been understudied. Objective Given the poor survival of women diagnosed with ovarian cancer, especially African-Americans, we examined whether diet-associated inflammation, a modifiable source of chronic systemic inflammation measured by the dietary inflammatory index (DII), was associated with all-cause mortality among African-American women with ovarian carcinoma. Methods Data were available from 490 ovarian carcinoma patients enrolled in a population-based case-control study of African-American women with ovarian cancer, the African-American Cancer Epidemiology Study. Energy-adjusted DII (E-DII) scores were calculated based on prediagnostic dietary intake of foods alone or foods and supplements, which was self-reported using the 2005 Block Food Frequency Questionnaire. Cox proportional hazards regression was used to estimate risk of mortality overall and for the most common histotype, high-grade serous carcinoma. Additionally, we assessed interaction by age at diagnosis and smoking status. Results Women included in this study had a median age of 57 y, and the majority of women were obese (58%), had late-stage disease (Stage III or IV, 66%), and had high-grade serous carcinoma (64%). Greater E-DII scores including supplements (indicating greater inflammatory potential) were associated with an increased risk of mortality among women with high-grade serous carcinoma (HR1-unit change: 1.08; 95% CI: 1.01, 1.17). Similar associations were observed for the E-DII excluding supplements, although not statistically significant (HR1-unit change: 1.07; 95% CI: 0.97, 1.17). There was an interaction by smoking status, where the positive association with mortality was present only among ever smokers (HRQuartile 4/Quartile 1: 2.36; 95% CI: 1.21, 4.60) but not among never smokers. Conclusions Greater inflammatory potential of prediagnostic diet may adversely impact prognosis among African-American women with high-grade serous carcinoma, and specifically among ever smokers.

Long-term anti-inflammatory diet in relation to improved breast cancer prognosis: a prospective cohort study

“…We failed to show that the effect of the E-DII on all-cause mortality in breast cancer survivors differed between smokers and non-smokers; a study focusing on high-grade serous ovarian carcinoma found a protective effect of anti-inflammatory diet on all-cause mortality risk among smokers 31 . Biologically, cigarette smoke contains many oxidants and free radicals and pro-inflammatory compounds that may activate endogenous mechanisms such as recruitment of neutrophils and macrophages to further increase the oxidant injury 40 .…”

“…However, they used the DII (not the E-DII) and did not consider dietary supplements 19 . Three studies 29 – 31 considered other cancer types in relation to post-diagnosis E-DII score on the risk of mortality, however, a post-diagnosis proinflammatory diet was not statistically significantly associated with mortality risk in cancer patients. Relatively short-term follow-up time and retrospective study designs maybe contribute to above-mentioned null results, which are similar to what we found when we examined the short duration (≤15 person-years) subgroup.…”

“…However, they used the DII (not the E-DII) and did not consider dietary supplements 19 . Three studies [29][30][31] considered other cancer Stratified by age of breast cancer diagnosis (≤60 years old, >60 years old), years from breast cancer diagnosis to DHQ completion (≤1 year, >1 year), stage (0/I, II/III) due to PH assumption violation and adjusted for total energy intake (continues, kcal/day), body mass index (continues, kg/m 2 ), trial arm (control, intervention), race (white, black, others), marital status (single, married, divorced or separated, widowed), income(<$20,000, $20,000-$49,000, $50,000-$99,000, $100,000-$200,000, <$200,000), educational level (less than high school, high school graduate or equivalent, post-high school education, college education or higher), smoking status (never smoked, past smoked, current smoked), hormone replacement therapy (never used, former used, current used), history of diabetes (no, yes), physical activity (active less than one time per month, active at least one time per month), estrogen receptor status (negative, positive), and progesterone receptor status (negative, positive). Adjusted for age of breast cancer diagnosis (continues), years from breast cancer diagnosis to DHQ completion (continues) total energy intake (continues, kcal/day), body mass index (continues, kg/m 2 ), trial arm (control, intervention), race (white, black, others), marital status (single, married, divorced or separated, widowed), income(<$20,000, $20,000-$49,000, $50,000-$99,000, $100,000-$200,000, <$200,000), educational level (less than high school, high school graduate or equivalent, post-high school education, college education or higher), smoking status (never smoked, past smoked, current smoked), hormone replacement therapy (never used, former used, current used), history of diabetes (no, yes), physical activity (active less than one time per month, active at least one time per month), stage (0/I, II/III), estrogen receptor status (negative, positive), and progesterone receptor status (negative, positive).…”

Survival of epithelial ovarian cancer in Black women: a society to cell approach in the African American Cancer Epidemiology Study (AACES)

“…Our approach evaluates how multiple factors can affect EOC survival through three levels: environmental (from neighborhood-level and census tract factors), individual (from data collected during interviews with each participant), and cellular (tumor immunity). In AACES we focus on in ammatory factors, given the strong role of in ammation in ovarian carcinogenesis and growing evidence of its role in prognosis [5].Given its size, geographical diversity, and breadth of data including biospecimens, the AACES cohort provides a unique resource to advance understanding of the multi-factorial causes of the ovarian cancer survival disparity in Black women. This information can in turn provide the foundational information needed to develop strategies to reduce and eventually eliminate this disparity.…”

“…Our approach evaluates how multiple factors can affect EOC survival through three levels: environmental (from neighborhood-level and census tract factors), individual (from data collected during interviews with each participant), and cellular (tumor immunity). In AACES we focus on in ammatory factors, given the strong role of in ammation in ovarian carcinogenesis and growing evidence of its role in prognosis [5].…”