Relationship between different forms of dietary choline and ovarian cancer survival: findings from the ovarian cancer follow-up study, a prospective cohort study

Abstract

Background: Choline has important and diverse functions in both cellular maintenance and growth. However, the relationships between the prediagnosis of the different forms of dietary choline intake and ovarian cancer (OC) survival are relatively unknown. This study is the first to investigate this topic based on the Ovarian Cancer Follow-Up Study, a prospective cohort study conducted in China. Methods: In the present study, 635 new cases of ovarian cancer between the ages of 18 and 79 were enrolled. A valid and reliable 111-item food frequency questionnaire was used to assess dietary choline intake. Deaths were ascertained until March 31, 2021, via medical records and active follow-up. Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During a median follow-up of 37.2 months (interquartile: 24.7–50.2 months), 114 deaths were identified. Higher lipid-soluble choline intake was significantly associated with better overall survival for patients with OC (Tertile 3 vs. Tertile 1: HR = 0.56; 95% CI: 0.34, 0.92; P trend = 0.02) in the fully adjusted model. Similar associations were observed for phosphatidylcholine intake (Tertile 3 vs. Tertile 1: HR = 0.55; 95% CI: 0.33, 0.91; P trend = 0.02). However, no associations were found between total water-soluble choline (free choline, phosphocholine, and glycerophosphocholine), sphingomyelin, and betaine intake and OC survival. Significant additive interactions between higher fat-soluble choline intake and positive expression of estrogen receptor and Wilms tumor-1 as well as higher phosphatidylcholine intake and positive expression of estrogen receptor and Wilms tumor-1 on OC survival were detected. Conclusions: Our findings indicate that prediagnosis, total lipid-soluble choline and phosphatidylcholine intake were associated with improved overall survival among OC patients.