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Int J Cancer. 2017 Jun 1;140(11):2422-2435. doi: 10.1002/ijc.30600. Epub 2017 Jan 24.

Cigarette smoking is associated with adverse survival among women with ovarian cancer: Results from a pooled analysis of 19 studies.

Author information

1
Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
2
Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark.
3
Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.
4
Centre for Cancer Research, The Westmead Millenium Institute for Medical Research, The University of Sydney Westmead, NSW, Australia.
5
Department of Gynecological Oncology, Westmead Hospital, Westmead, NSW, Australia.
6
Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
7
Molecular Unit, Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
8
Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
9
Department of Epidemiology, University of Washington, Seattle, WA.
10
Department of Epidemiology, The Geisel School of Medicine, Dartmouth College, Hanover, NH.
11
Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
12
Community and Population Health Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA.
13
Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
14
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
15
Ovarian Cancer Center of Excellence, Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, PA.
16
Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY.
17
School of Public Health, The University of Texas, Houston, TX.
18
Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan.
19
Division of Epidemiology and Prevention, Aichi Cancer Center Research institute, Nagoya, Aichi, Japan.
20
Department of Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, MN.
21
Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
22
University of Kansas Medical Center, Kansas City, KS.
23
Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA.
24
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
25
Department of Public Health Science, School of Medicine, University of Virginia, Charlottesville, VA.
26
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.
27
Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
28
Rutgers School of Public Health, Piscataway, NJ.
29
New Jersey Department of Health and Senior Services, Trenton, NJ.
30
School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ.
31
Department of Gynaecology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.
32
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
33
Department of Oncology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research laboratory, Cambridge, United Kingdom.
34
Department of Health Research and Policy - Epidemiology, Stanford University School of Medicine, Stanford, CA.
35
Departments of Health Research & Policy and of Biomedical Data Science, Stanford School of Medicine, Stanford, CA.
36
Departments of Population Health Science & Policy and of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY.
37
Department of Epidemiology, Center for Cancer Genetics Research & Prevention, School of Medicine, University of California Irvine, Irvine, CA.
38
Department of Epidemiology, University of California Irvine, Irvine, CA.
39
Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom.
40
Center for Cancer Prevention and Translational Genomics, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
41
Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA.
42
School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
43
The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.
44
Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA.
45
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
46
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
47
Department of Health Science, California State University, Fullerton, CA.
48
Epidemiology Center, College of Medicine, University of South Florida, Tampa, FL.
49
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
50
University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
51
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
52
Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Abstract

Cigarette smoking is associated with an increased risk of developing mucinous ovarian tumors but whether it is associated with ovarian cancer survival overall or for the different histotypes is unestablished. Furthermore, it is unknown whether the association between cigarette smoking and survival differs according to strata of ovarian cancer stage at diagnosis. In a large pooled analysis, we evaluated the association between various measures of cigarette smoking and survival among women with epithelial ovarian cancer. We obtained data from 19 case-control studies in the Ovarian Cancer Association Consortium (OCAC), including 9,114 women diagnosed with ovarian cancer. Cox regression models were used to estimate adjusted study-specific hazard ratios (HRs), which were combined into pooled hazard ratios (pHR) with corresponding 95% confidence intervals (CIs) under random effects models. Overall, 5,149 (57%) women died during a median follow-up period of 7.0 years. Among women diagnosed with ovarian cancer, both current (pHR = 1.17, 95% CI: 1.08-1.28) and former smokers (pHR = 1.10, 95% CI: 1.02-1.18) had worse survival compared with never smoking women. In histotype-stratified analyses, associations were observed for mucinous (current smoking: pHR = 1.91, 95% CI: 1.01-3.65) and serous histotypes (current smoking: pHR = 1.11, 95% CI: 1.00-1.23; former smoking: pHR = 1.12, 95% CI: 1.04-1.20). Further, our results suggested that current smoking has a greater impact on survival among women with localized than disseminated disease. The identification of cigarette smoking as a modifiable factor associated with survival has potential clinical importance as a focus area to improve ovarian cancer prognosis.

KEYWORDS:

cigarette smoking; ovarian cancer; pooled analysis; survival

PMID:
28063166
PMCID:
PMC5489656
DOI:
10.1002/ijc.30600
[Indexed for MEDLINE]
Free PMC Article

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