ImportanceIt remains unclear whether diet may influence the risk of prostate cancer grade reclassification in men undergoing active surveillance.ObjectiveTo assess the association of diet quality and dietary inflammatory potential with prostate cancer grade reclassification during active surveillance.Design, Setting, and ParticipantsThis prospective cohort study included men diagnosed with grade group (GG) 1 prostate cancer from January 2005 to February 2017 who were undergoing active surveillance and at active surveillance enrollment prospectively completed a validated food frequency questionnaire regarding their usual dietary patterns. Data were analyzed from October 29, 2023, to June 17, 2024.ExposuresThe Healthy Eating Index 1999-2000 (HEI) and energy-adjusted HEI (E-HEI) scores as a measure of adherence to the Dietary Guidelines for Americans and the Dietary Inflammatory Index (DII) and energy-adjusted DII (E-DII) scores as metrics of dietary inflammatory potential were calculated using self-reported diet data.Main Outcomes and MeasuresA competing risk regression was performed to test the baseline HEI, E-HEI, DII, and E-DII scores for an association with grade reclassification to GG2 or greater or GG3 or greater (ie, extreme grade reclassification) during active surveillance, adjusting for established active surveillance prognostic factors and smoking history at baseline.ResultsThe study included 886 men (median age at diagnosis, 66 years [IQR, 61-69 years]). After median follow-up of 6.5 years (IQR, 4.0-9.1 years), 187 (21%) had grade reclassification to GG2 or greater, including 55 (6%) with extreme grade reclassification. The cumulative incidence of grade reclassification was 7% (95% CI, 5%-9%) at 3 years, 15% (95% CI, 12%-17%) at 5 years, and 33% (95% CI, 29%-37%) at 10 years; that of extreme grade reclassification was 2% (95% CI, 1%-4%) at 3 years, 4% (95% CI, 3%-5%) at 5 years, and 10% (95% CI, 7%-13%) at 10 years. Higher baseline HEI (subdistribution hazard ratio [SHR], 0.85; 95% CI, 0.73-0.98; P = .03) and E-HEI (SHR, 0.86; 95% CI, 0.74-1.00; P = .047) per 1-SD increase in score were associated with a significantly lower risk of grade reclassification. Higher baseline HEI (SHR, 0.72; 95% CI, 0.57-0.93; P = .01) and E-HEI (SHR, 0.73; 95% CI, 0.57-0.94; P = .01) per 1-SD increase in score were associated with a significantly lower risk of extreme grade reclassification. Neither the baseline DII nor E-DII was associated with either grade reclassification outcome (eg, for grade reclassification to ≥GG2, the SHR was 1.08 [95% CI, 0.93-1.26] per 1-SD increase in DII score and 1.02 [95% CI, 0.86-1.21] per 1-SD increase in E-DII score).Conclusions and RelevanceThe findings suggest that in men diagnosed with GG1 prostate cancer undergoing active surveillance, higher adherence to American dietary guideline recommendations may be associated with a lower risk of grade reclassification, particularly to GG3 or greater disease, which mandates curative treatment.

中文翻译：

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饮食质量、饮食炎症可能性和前列腺癌分级重新分类的风险


重要性目前尚不清楚饮食是否会影响接受主动监测的男性前列腺癌分级重新分类的风险。目的评估主动监测期间饮食质量和饮食炎症潜力与前列腺癌分级重新分类的相关性。设计、设置和参与者这项前瞻性队列研究包括 2005 年 1 月至 2017 年 2 月被诊断患有 1 级 （GG） 前列腺癌的男性，他们正在接受主动监测，并在主动监测登记中前瞻性地完成了一份经过验证的食物频率问卷关于他们通常的饮食模式。数据分析时间为 2023 年 10 月 29 日至 2024 年 6 月 17 日。主要结局和测量进行竞争风险回归，以检验基线 HEI、E-HEI、DII 和 E-DII 评分与主动监测期间等级重分类为 GG2 或更高或 GG3 或更高（即极端等级重分类）的关联，调整已建立的主动监测预后因素和基线时的吸烟史。结果该研究包括 886 名男性 （诊断时的中位年龄，66 岁 [IQR，61-69 岁]）。中位随访 6.5 年 （IQR，4.0-9.1 年） 后，187 例 （21%） 分级重新分级为 GG2 或更高，其中 55 例 （6%） 分级极端。 分级再分类的累积发生率在 3 年时为 7% （95% CI，5%-9%），5 年时为 15% （95% CI，12%-17%），10 年时为 33% （95% CI，29%-37%）;极端分级再分类的比率为 3 年时为 2% （95% CI， 1%-4%），5 年时为 4% （95% CI， 3%-5%），10 年时为 10% （95% CI， 7%-13%）。较高的基线 HEI（亚分布风险比 [SHR]，0.85;95% CI，0.73-0.98;P = .03） 和 E-HEI （SHR， 0.86;95% CI， 0.74-1.00;P = .047） 分数每增加 1-SD 与等级重新分类的风险显着降低相关。较高的基线 HEI（SHR，0.72;95% CI，0.57-0.93;P = .01） 和 E-HEI （SHR， 0.73;95% CI， 0.57-0.94;P = .01） 分数每增加 1-SD 与极端等级重新分类的风险显着降低相关。基线 DII 和 E-DII 均与任一等级重分类结局无关（例如，对于等级重分类为 ≥GG2，SHR 为 DII 评分每增加 1-SD 为 1.08 [95% CI，0.93-1.26]，E-DII 评分每增加 1-SD 为 1.02 [95% CI，0.86-1.21]）。结论和相关性研究结果表明，在接受主动监测的被诊断患有 GG1 前列腺癌的男性中，对美国饮食指南建议的更高依从性可能与较低的等级重新分类风险相关，尤其是 GG3 或更严重的疾病，这需要根治性治疗。