Association Between Dietary Vitamin Intake and All-cause Mortality in Ovarian Cancer Patients: A Prospective Cohort Study

Qin LingWu LinxiangHuishan XuYang ZhangYuying ChenTingting SunZuwei ZhangHuiling LaiShasha HeShuzhong YaoWeipeng He ##^*Guofen Yang^*

• The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

Background: While various lifestyle factors have been implicated in cancer prognosis, the role of dietary vitamins in ovarian cancer survival is not well understood. This study aimed to investigate the association between dietary vitamin intake and all-cause mortality in ovarian cancer patients, presenting a potential modifiable avenue for improving outcomes.: Data were obtained from 7 consecutive National Health and Nutrition Examination Survey (NHANES) cycles between 2003-2016, including 108 ovarian cancer patients. Mortality outcomes were ascertained by matching the National Death Index (NDI). To investigate the association between vitamin consumption and allcause mortality, multivariate Cox proportional hazards models was employed. Nonlinear relationships were further assessed through restricted cubic spline analyses and subgroup analyses were conducted to explore the influence of potential confounders.Results: A total of 108 ovarian cancer patients were included, of which 24 participants have died. In the adjusted model, higher vitamin A intake was significantly associated with an increased all-cause mortality (HR = 3.826; 95% CI = 1.378-10.627; P=0.01). In contrast, higher intake of vitamins B1 and B2 was associated with improved survival (HR = 0.234, 95% CI = 0.077-0.71, P=0.01; HR = 0.14, 95% CI = 0.048-0.408, P <0.001). Vitamin C intake showed a complex relationship with survival: the highest tertile had an increased risk of death (HRT3 vs. T1 = 4.106; 95% CI = 1.294-13.032; P=0.017) , while the moderate tertile were just the opposite (HRT2 vs. T1 = 0.097; 95% CI = 0.013-0.75; P=0.025).Nonlinear associations were exhibited between vitamins A, B1, and B2 with all-cause mortality (p-nonlinear=0.007, 0.008, 0.027). Subgroup analyses revealed that the education level, racial and smoking status differences may cause difference in results.Conclusions: This study suggests that higher dietary intake of vitamin A may increase mortality risk in ovarian cancer patients, while vitamins B1 and B2 may offer potential survival benefits. The relationship between vitamin C and survival varied with intake levels. These results highlight the potential for personalized dietary interventions in ovarian cancer management.