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Cancer Causes Control. 2019 May;30(5):537-547. doi: 10.1007/s10552-019-01157-3. Epub 2019 Mar 23.

Joint exposure to smoking, excessive weight, and physical inactivity and survival of ovarian cancer patients, evidence from the Ovarian Cancer Association Consortium.

Author information

1
Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, A-352 Carlton House, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
2
Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
3
Deparment of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
4
Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
5
The University of Queensland, School of Public Health, Herston, QLD, Australia.
6
Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, and UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
7
START Center for Cancer Care, San Antonio, TX, USA.
8
Department of Surgery, Division of Gynecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
9
Center of Immunotherapy, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
10
Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
11
Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA, USA.
12
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
13
Department of Epidemiology, The Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
14
Department of Gynecological Oncology, Westmead Hospital and the Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.
15
Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
16
Ovarian Cancer Center of Excellence, Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
17
Division of Epidemiology, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA.
18
Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
19
Department of Pathology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
20
Division of Molecular Medicine and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan.
21
Department of Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
22
Department of Gynecological Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
23
School of Public Health, The University of Texas, Houston, TX, USA.
24
New Jersey Department of Health and Senior Services, New Jersey State Cancer Registry, Trenton, NJ, USA.
25
Rutgers Cancer Institute, New Brunswick, NJ, USA.
26
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
27
Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
28
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
29
Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
30
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
31
Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, A-352 Carlton House, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA. kirsten.moysich@roswellpark.org.
32
Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. kirsten.moysich@roswellpark.org.

Abstract

PURPOSE:

Previous epidemiologic studies have shown that smoking, obesity, and physical inactivity are associated with poor survival following a diagnosis of ovarian cancer. Yet, the combined relationship of these unfavorable lifestyle factors on ovarian cancer survival has not been sufficiently investigated.

METHODS:

Using data pooled from 13 studies, we examined the associations between combined exposures to smoking, overweight/obesity weight, and physical inactivity and overall survival (OS) as well as progression-free survival (PFS) among women diagnosed with invasive epithelial ovarian carcinoma (n = 7,022). Using age- and stage-adjusted Cox proportional hazards regression models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) associated with joint exposure to these factors.

RESULTS:

Combined exposure to current smoking, overweight/obesity, and physical inactivity prior to diagnosis was associated with a significantly increased risk of mortality compared to women who never smoked, had normal body mass index (BMI), and were physically active (HR = 1.37; 95% CI 1.10-1.70). The association for a joint exposure to these factors exceeded that of each exposure individually. In fact, exposure to both current smoking and overweight/obesity, and current smoking and physical inactivity was also associated with increased risk of death (HR = 1.28; 95% CI 1.08-1.52, and HR = 1.26; 95% CI 1.04-1.54, respectively). The associations were of a similar magnitude when former smoking was assessed in combination with the other exposures and when excessive weight was limited to obesity only. No significant associations were observed between joint exposure to any of these factors and PFS.

CONCLUSIONS:

Joint exposure to smoking, excessive weight, and physical inactivity may negatively impact survival of ovarian cancer patients. These results suggest the importance of examining the combined effect of lifestyle factors on ovarian cancer patients' survival.

KEYWORDS:

Obesity; Ovarian cancer survival; Overweight; Physical inactivity; Prognosis; Smoking cigarettes

PMID:
30905014
DOI:
10.1007/s10552-019-01157-3
[Indexed for MEDLINE]

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