| Summary: | Background: Current biological evidence suggests that purine involvement in purine metabolism may contribute to the development and progression of ovarian cancer (OC), but the epidemiological association is currently unknown. Methods: A total of 703 newly diagnosed patients with OC aged 18–79 years were included in this prospective cohort study. Utilizing a verified food-frequency questionnaire, the participants’ dietary consumption was gathered. Using medical records and ongoing follow-up, the deaths up until 31 March 2021 were determined. To assess the hazard ratios (HRs) and 95% confidence intervals (CIs) of purine intake with OC mortality, Cox proportional-hazard models were utilized. Results: During the median follow-up of 31 months (interquartile: 20–47 months), 130 deaths occurred. We observed an improved survival for the highest tercile of total purine intake compared with the lowest tercile (HR = 0.39, 95% CI = 0.19–0.80; <i>p</i> trend < 0.05), and this protective association was mainly attributed to xanthine intake (HR = 0.52, 95% CI = 0.29–0.94, <i>p</i> trend < 0.05). Additionally, we observed a curving relationship in which OC mortality decreased with total purine intake, and the magnitude of the decrease was negatively correlated with intake (<i>p</i> non-linear < 0.05). Significant inverse associations were also observed in subgroup analyses and sensitivity analyses according to demographic and clinical characteristics. Moreover, we observed that xanthine intake and hypoxanthine intake had a multiplicative interaction with ER and PR expression (<i>p</i> < 0.05), respectively. Conclusion: A high total purine and xanthine intake was linked to a lower risk of OC mortality. Further clarification of these findings is warranted.
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