饮食与生活方式质量与子宫内膜癌：发病率与生存结局——系统综述与荟萃分析的伞状综述。
完整摘要 · 中文译文
复合膳食和生活方式指数捕捉了多种健康相关行为的综合效应，可能比单一暴露因素更能反映现实世界中的癌症风险和生存情况。本伞状综述旨在评价和分级关于复合膳食和生活方式质量指数依从性与子宫内膜癌（EC）结局之间关联的证据强度，这些结局包括风险、EC特异性生存、总生存、疾病复发、生活质量和新发心脏代谢疾病。系统检索了PubMed、Embase、Scopus、Web of Science、CINAHL和Cochrane Library数据库中的相关系统综述。使用预先设定的伞状综述标准对证据进行分级。共纳入21篇系统综述。其中9篇研究了膳食质量（7篇进行了荟萃分析），12篇研究了生活方式暴露或干预（8篇进行了荟萃分析）。评估的结局包括EC风险（N = 14）、全因或癌症特异性死亡率（N = 5）、复发（N = 4）、总生存或癌症特异性生存（N = 3）、生活质量（N = 5）和心脏代谢事件（N = 1）。遵循地中海饮食与EC发生几率降低29%相关（合并OR = 0.71，95% CI 0.51-0.98；IV级），而西方膳食模式与EC发生几率升高20%相关（合并OR = 1.20，95% CI 1.03-1.39；IV级）。健康膳食与生活方式相结合的方法与EC发病风险降低46%相关（合并HR = 0.54，95% CI 0.42-0.71；III级），尽管异质性较高。未观察到生活方式干预与 在从9周到12个月不等的随访期间内，干预措施与整体或特定领域的生活质量（QoL）之间的关系，无论使用何种经过验证的评估工具。关于饮食和生活方式因素与子宫内膜癌（EC）复发、生存、死亡率及心脏代谢结局之间关联的证据仍然有限。我们的伞状综述确定了提示性（III-IV类）证据，表明健康饮食模式（尤其是地中海饮食）以及综合健康生活方式方法与较低的EC发病率相关。关于诊断后结局的证据仍然不足或不显著，强调了进一步开展高质量研究的必要性。
完整摘要 · 英文原文
Composite dietary and lifestyle indices capture the combined effects of multiple health-related behaviours and may better reflect real-world cancer risk and survivorship than single exposures. This umbrella review aimed to evaluate and grade the strength of evidence for associations between adherence to composite dietary and lifestyle quality indices and endometrial cancer (EC) outcomes, including risk, EC-specific survival, overall survival, disease recurrence, quality of life, and new-onset cardiometabolic diseases. PubMed, Embase, Scopus, Web of Science, CINAHL, and Cochrane Library databases were systematically searched for relevant systematic reviews. Evidence was graded using prespecified umbrella review criteria. A total of 21 systematic reviews were included. Nine investigated diet quality (7 meta-analyses) and 12 investigated lifestyle exposure or interventions (8 meta-analyses). The outcomes assessed were EC risk (N = 14), all-cause or cancer-specific mortality (N = 5), recurrence (N = 4), overall or cancer-specific survival (N = 3), QoL (N = 5), and cardiometabolic events (N = 1). Following a Mediterranean diet was associated with 29% lower odds of EC (pooled OR = 0.71, 95% CI 0.51-0.98; class IV), whereas Western dietary patterns were associated with 20% higher odds of EC (pooled OR = 1.20, 95% CI 1.03-1.39; class IV). A combined healthy diet and lifestyle approach was associated with a 46% lower hazard of EC incidence (pooled HR = 0.54, 95% CI 0.42-0.71; class III), although heterogeneity was high. No significant associations were observed between lifestyle interventions and global or domain-specific quality of life (QoL) across follow-up durations ranging from 9 weeks to 12 months, irrespective of the validated assessment instruments used. Evidence remains limited regarding the associations between diet and lifestyle factors and EC recurrence, survival, mortality, and cardiometabolic outcomes. Our umbrella review identified suggestive (class III-IV) evidence for associations between healthy dietary patterns, particularly the Mediterranean diet, and combined healthy lifestyle approaches with lower EC incidence. Evidence remains insufficient or non-significant for post-diagnosis outcomes, underscoring the need for further high-quality research.