摘要Objective:Plant-based diets have multiple health benefits for cancers;however,little is known about the association between plant-based dietary patterns and esophageal cancer(EC).This study presents an investigation of the prospective associations among three predefined indices of plant-based dietary patterns and the risk of EC.Methods:We performed endoscopic screening for 15,709 participants aged 40-69 years from two high-risk areas of China from January 2005 to December 2009 and followed the cohort until December 31,2022.The overall plant-based diet index(PDI),healthful plant-based diet index(hPDI),and unhealthful plant-based diet index(uPDI),were calculated using survey responses to assess dietary patterns.We applied Cox proportional hazard regression to estimate the multivariable hazard ratios(HRs)and 95％confidence intervals(95％CIs)of EC across 3 plant-based diet indices and further stratified the analysis by subgroups.Results:The final study sample included 15,184 participants in the cohort.During a follow-up of 219,365 person-years,176 patients with EC were identified.When the highest quartile was compared with the lowest quartile,the pooled multivariable-adjusted HR of EC was 0.50(95％CI,0.32-0.77)for hPDI.In addition,the HR per 10-point increase in the hPDI score was 0.42(95％CI,0.27-0.66)for ECs.Conversely,uPDI was positively associated with the risk of EC,and the HR was 1.80(95％CI,1.16-2.82).The HR per 10-point increase in the uPDI score was 1.90(95％CI,1.26-2.88)for ECs.The associations between these scores and the risk of EC were consistent in most subgroups.These results remained robust in sensitivity analyses.Conclusions:A healthy plant-based dietary pattern was associated with a reduced risk of EC.Emphasizing the healthiness and quality of plant-based diets may be important for preventing the development of EC.