Shafrir Amy L, Babic Ana, Tamimi Rulla M, Rosner Bernard A, Tworoger Shelley S, Terry Kathryn L
Department of Epidemiology, Harvard TH Chan School of Public Health, 677 Huntington Avenue, 9th Floor, Boston, MA 02115, USA.
Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA.
Br J Cancer. 2016 Nov 22;115(11):1391-1399. doi: 10.1038/bjc.2016.316. Epub 2016 Oct 4.
Ovarian cancer survival is poor, particularly for platinum-resistant cases. The previous literature on pre-diagnostic reproductive factors and ovarian cancer survival has been mixed. Therefore, we evaluated pre-diagnostic reproductive and hormonal factors with overall survival and, additionally, platinum-chemotherapy resistance.
We followed 1649 invasive epithelial ovarian cancer cases who were enrolled between 1992 and 2008 for overall mortality within the New England Case-Control Study and abstracted chemotherapy data on a subset (n=449). We assessed pre-diagnostic reproductive and hormonal factors during in-person interviews. We calculated hazard ratios (HRs) using Cox-proportional hazards models.
We observed 911 all-cause deaths among 1649 ovarian cancer cases. Self-reported endometriosis and longer duration of hormone therapy use were associated with improved survival (HR: 0.72; 95% confidence interval (CI): 0.54-0.94 and HR, ⩾5 years vs never: 0.70; 95% CI: 0.55-0.90, respectively). Older age at menopause and menarche were associated with worse survival (HR, ⩽50 vs >50 years: 1.23; 95% CI: 1.03-1.46 and HR, 13 vs <13 years: 1.24; 95% CI: 1.06-1.44, respectively). We observed no association between oral contraceptive use, parity and tubal ligation, and overall survival. No significant associations were observed for any of the reproductive and hormonal factors and platinum resistance.
These results suggest that pre-diagnostic exposures such as endometriosis and HT use may influence overall survival among ovarian cancer patients.
卵巢癌患者的生存率较低，尤其是铂耐药病例。先前关于诊断前生殖因素与卵巢癌生存率的文献结论不一。因此，我们评估了诊断前的生殖和激素因素与总生存率以及铂类化疗耐药性之间的关系。
在新英格兰病例对照研究中，我们对1992年至2008年间登记的1649例浸润性上皮性卵巢癌病例进行随访，以了解其全因死亡率，并提取了其中一部分病例（n = 449）的化疗数据。我们在面对面访谈中评估了诊断前的生殖和激素因素。我们使用Cox比例风险模型计算风险比（HRs）。
在1649例卵巢癌病例中，我们观察到911例全因死亡。自我报告的子宫内膜异位症和较长的激素治疗使用时间与生存率提高相关（HR：0.72；95%置信区间（CI）：0.54 - 0.94；HR，使用⩾5年与从未使用相比：0.70；95%CI：0.55 - 0.90）。绝经和初潮年龄较大与生存率较差相关（HR，⩽50岁与>50岁相比：1.23；95%CI：1.03 - 1.46；HR，13岁与<13岁相比：1.24；95%CI：1.06 - 1.44）。我们未观察到口服避孕药使用、生育次数和输卵管结扎与总生存率之间存在关联。对于任何生殖和激素因素与铂耐药性，均未观察到显著关联。
这些结果表明，诊断前的暴露因素，如子宫内膜异位症和激素治疗的使用，可能会影响卵巢癌患者的总生存率。
