BACKGROUND: Prognosis after a diagnosis of invasive epithelial ovarian cancer is poor. Some studies have suggested modifiable behaviors, like diet, are associated with survival but the evidence is inconsistent. OBJECTIVES: This study aims to pool data from studies conducted around the world to evaluate the relationship among dietary indices, foods, and nutrients from food sources and survival after a diagnosis of ovarian cancer. METHODS: This analysis from the Multidisciplinary Ovarian Cancer Outcomes Group within the Ovarian Cancer Association Consortium included 13 studies with 7700 individuals with ovarian cancer, who completed food-frequency questionnaires regarding their prediagnosis diet. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for associations with overall survival were estimated using Cox proportional hazards models. RESULTS: Overall, there was no association between any of the 7 dietary indices (representing prediagnosis diet) evaluated and survival
  however, associations differed by tumor stage. Although there were no consistent associations among those with advanced disease, among those with earlier stage (local/regional) disease, higher scores on the alternate Healthy Eating Index (aHR quartile 4 compared with 1 = 0.66, 95% CI: 0.50, 0.87), Healthy Eating Index-2015 (aHR: 0.75
  95% CI: 0.59, 0.97), and alternate Mediterranean diet (aHR: 0.76
  95% CI: 0.60, 0.98) were associated with better survival. Better survival was also observed for individuals with early-stage disease who reported higher intakes of dietary components that contribute to the healthy diet indices (aHR for Q4 compared with Q1: vegetables 0.71
  95% CI: 0.56, 0.91), tomatoes (aHR: 0.72
  95% CI: 0.57, 0.91) and nuts and seeds (aHR 0.71
  95% CI: 0.55, 0.92). In contrast, there were suggestions of worse survival with higher scores on 2 of the 3 inflammatory indices and higher intake of trans-fatty acids. CONCLUSIONS: Adherence to a more healthy, less-inflammatory diet may confer a survival benefit for individuals with early-stage ovarian cancer.
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