High Prediagnosis Inflammation-Related Risk Score Associated with Decreased Ovarian Cancer Survival.
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan.
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
- Department of Medicine, School of Medicine, University of California Irvine, Irvine, California.
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
- Centre for Cancer Research, The Westmead Institute for Medical Research, and The University of Sydney, Westmead, New South Wales, Australia.
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, Utah.
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, UCL, London, United Kingdom.
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
- Cancer Prevention and Genetics Program, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.
- Women's Cancer Research Center, Magee-Women's Research Institute and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania.
- Division of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
- School of Women's and Children's Health, Faculty of Medicine, University of NSW Sydney, Sydney, New South Wales, Australia.
- Chronic Disease Epidemiology Department, Yale School of Public Health, New Haven, Connecticut.
- Emory University Rollins School of Public Health, Atlanta, Georgia.
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
- Division of Computational Biology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
- Patient Advocate.
- University of Chicago Medicine Comprehensive Cancer Center, Chicago, Illinois.
- Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada.
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom.
- Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom.
- Division of Gynecologic Oncology, Duke University School of Medicine, Durham, North Carolina.
- Department of Obstetrics & Gynecology, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
BACKGROUND: There is suggestive evidence that inflammation is related to ovarian cancer survival. However, more research is needed to identify inflammation-related factors that are associated with ovarian cancer survival and to determine their combined effects.
METHODS: This analysis used pooled data on 8,147 women with invasive epithelial ovarian cancer from the Ovarian Cancer Association Consortium. The prediagnosis inflammation-related exposures of interest included alcohol use; aspirin use; other nonsteroidal anti-inflammatory drug use; body mass index; environmental tobacco smoke exposure; history of pelvic inflammatory disease, polycystic ovarian syndrome, and endometriosis; menopausal hormone therapy use; physical inactivity; smoking status; and talc use. Using Cox proportional hazards models, the relationship between each exposure and survival was assessed in 50% of the data. A weighted inflammation-related risk score (IRRS) was developed, and its association with survival was assessed using Cox proportional hazards models in the remaining 50% of the data.
RESULTS: There was a statistically significant trend of increasing risk of death per quartile of the IRRS [HR = 1.09; 95% confidence interval (CI), 1.03-1.14]. Women in the upper quartile of the IRRS had a 31% higher death rate compared with the lowest quartile (95% CI, 1.11-1.54).
CONCLUSIONS: A higher prediagnosis IRRS was associated with an increased mortality risk after an ovarian cancer diagnosis. Further investigation is warranted to evaluate whether postdiagnosis exposures are also associated with survival.
IMPACT: Given that pre- and postdiagnosis exposures are often correlated and many are modifiable, our study results can ultimately motivate the development of behavioral recommendations to enhance survival among patients with ovarian cancer.