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. 2020 Apr 6;20(1):287.
doi: 10.1186/s12885-020-06767-8.

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

Li-Ping Sun  1 , Lu-Bin Yan  2 , Zhen-Zhen Liu  3 , Wen-Jing Zhao  4 , Cai-Xia Zhang  1 , Yu-Min Chen  1 , Xiang Qian Lao  5 , Xudong Liu  6
Affiliations

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

Li-Ping Sun et al. BMC Cancer. .

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.

Keywords: Dietary intake; Esophageal Cancer; Meta-analysis; Mortality; Systematic review.

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Conflict of interest statement

All authors declared that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the literature selection. Abbreviation: WOS, Web of Science; HR, hazard ratio; RR, relative risk; OR, odd ratio; EC, esophageal cancer; ESCC, esophageal squamous cell carcinoma; EAC, esophageal adenocarcinoma. CNKI and Wanfang are Chinese database, CNKI: http://new.oversea.cnki.net/index/; Wanfang: http://www.wanfangdata.com.cn/resource_nav/index.do
Fig. 2
Fig. 2
Forest plot of association between dietary folate intake (highest vs. lowest) and esophageal cancer-specific mortality among patients with esophageal squamous cell carcinoma
Fig. 3
Fig. 3
The funnel plot with Pseudo 95% confidence limits on dietary folate intake and esophageal cancer-specific mortality among patients with esophageal squamous cell carcinoma
Fig. 4
Fig. 4
Forest plot of association between alcohol consumption (highest vs. lowest) and risk of mortality by cancer type. Abbreviation: EC, esophageal cancer; EAC, esophageal adenocarcinoma; ESCC, esophageal squamous cell carcinoma
Fig. 5
Fig. 5
The funnel plot with Pseudo 95% confidence limits on alcohol consumption and risk of mortality by cancer type
See this image and copyright information in PMC

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