Table 3.
Multivariable-adjusted associations between E-DII from diet plus supplements and mortality outcomes (all-cause and cancer mortality) stratified by cancer stage and cancer grade in the WHI-DM and OS.
| Subgroups | E-DII Quartile 1 | E-DII Quartile 2 | E-DII Quartile 3 | E-DII Quartile 4 | P-trenda | P-interactionb |
|---|---|---|---|---|---|---|
| All-cause mortality | ||||||
| Cancer stage | 0.34 | |||||
| Localised stage, n (%)c | 128 (20.7) | 150 (25.3) | 149 (26.5) | 165 (30.2) | ||
| MV-adjusted HR (95% CI)d | 0.70 (0.55–0.90) | 0.84 (0.66–1.06) | 0.87 (0.70–1.09) | 1.00 (ref) | 0.004 | |
| Regional stage, n (%)c | 57 (32.8) | 80 (42.8) | 98 (44.3) | 93 (44.3) | ||
| MV-adjusted HR (95% CI)d | 0.63 (0.44–0.90) | 0.88 (0.64–1.22) | 0.91 (0.68–1.23) | 1.00 (ref) | 0.02 | |
| Distant stage, n (%)c | 41 (61.2) | 54 (69.2) | 55 (73.3) | 86 (84.3) | ||
| MV-adjusted HR (95% CI)d | 0.36 (0.24–0.55) | 0.59 (0.41–0.86) | 0.72 (0.50–1.03) | 1.00 (ref) | <0.001 | |
| Cancer gradee | 0.19 | |||||
| Well differentiated, n (%)c | 30 (18.5) | 33 (17.9) | 38 (25.2) | 33 (25.4) | ||
| MV-adjusted HR (95% CI)d | 0.88 (0.51–1.52) | 0.65 (0.39–1.10) | 1.02 (0.63–1.66) | 1.00 (ref) | 0.33 | |
| Moderately differentiated, n (%)c | 79 (25.1) | 82 (30.1) | 106 (33.4) | 114 (37.9) | ||
| MV-adjusted HR (95% CI)d | 0.65 (0.48–0.89) | 0.87 (0.64–1.17) | 0.98 (0.74–1.29) | 1.00 (ref) | 0.02 | |
| Poorly differentiated, n (%)c | 47 (29.2) | 70 (40.0) | 63 (42.6) | 75 (40.8) | ||
| MV-adjusted HR (95% CI)d | 0.67 (0.44–1.01) | 0.99 (0.70–1.41) | 1.10 (0.78–1.56) | 1.00 (ref) | 0.21 | |
| Total cancer mortality | ||||||
| Cancer stage | 0.48 | |||||
| Localised stage, n (%)c | 57 (9.2) | 65 (11.0) | 68 (12.1) | 67 (12.3) | ||
| MV-adjusted HR (95% CI)d | 0.71 (0.49–1.04) | 0.88 (0.61–1.25) | 0.97 (0.69–1.37) | 1.00 (ref) | 0.04 | |
| Regional stage, n (%)c | 44 (25.3) | 58 (31.0) | 69 (31.2) | 66 (31.4) | ||
| MV-adjusted HR (95% CI)d | 0.69 (0.46–1.05) | 0.89 (0.61–1.30) | 0.91 (0.64–1.30) | 1.00 (ref) | 0.09 | |
| Distant stage, n (%)c | 36 (53.7) | 44 (56.4) | 47 (62.7) | 74 (72.6) | ||
| MV-adjusted HR (95% CI)d | 0.38 (0.24–0.60) | 0.57 (0.38–0.86) | 0.75 (0.51–1.11) | 1.00 (ref) | <0.001 | |
| Cancer gradee | 0.29 | |||||
| Well differentiated, n (%)c | 15 (9.3) | 12 (6.5) | 15 (9.9) | 14 (10.8) | ||
| MV-adjusted HR (95% CI)d | 1.12 (0.49–2.56) | 0.58 (0.25–1.37) | 0.88 (0.40–1.91) | 1.00 (ref) | 0.76 | |
| Moderately differentiated, n (%)c | 45 (14.3) | 45 (16.5) | 55 (17.4) | 62 (20.6) | ||
| MV-adjusted HR (95% CI)d | 0.68 (0.44–1.03) | 0.86 (0.57–1.30) | 0.94 (0.64–1.37) | 1.00 (ref) | 0.12 | |
| Poorly differentiated, n (%)c | 30 (18.6) | 48 (27.4) | 47 (31.8) | 45 (24.5) | ||
| MV-adjusted HR (95% CI)d | 0.64 (0.39–1.07) | 1.07 (0.69–1.67) | 1.26 (0.82–1.93) | 1.00 (ref) | 0.25 | |
aLinear trend test represented the P-value for the continuous E-DII variable.
bInteraction test was performed by adding the cross-product of E-DII quartile and cancer stage or grade in the multivariable-adjusted model (MV model).
cNumber of deaths from the specific cause and proportion of deaths from the cause among the total number of cancer cases within each quartile.
dThe MV model was adjusted for age at cancer diagnosis, income levels, WHI study arm, race/ethnicity, education levels, years from cancer diagnosis to FFQ, baseline physical activity in MET-h/week, smoking status at baseline, total energy intake per day, BMI, cancer stage and cancer grade with the time-dependent covariate in the model to stratify participants’ status before and after the post-diagnosis FFQ.
eThree categories of cancer grade were included while other types including “unknown/not done,” B cell or T cell and Anaplastic were not included because of unknown grade status for interpretation or few case numbers that resulted in unstable estimates.