Kim Shana J, Rosen Barry, Fan Isabel, Ivanova Anna, McLaughlin John R, Risch Harvey, Narod Steven A, Kotsopoulos Joanne
Women's College Research Institute, Women's College Hospital, 76 Grenville, Toronto, ON, Canada.
Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
Br J Cancer. 2017 Mar 28;116(7):964-971. doi: 10.1038/bjc.2017.35. Epub 2017 Feb 16.
Various epidemiologic factors have been shown to influence the risk of ovarian cancer development. Given the high fatality associated with this disease, it is of interest to evaluate the association of prediagnostic hormonal, reproductive, and lifestyle exposures with ovarian cancer-specific survival.
We included 1421 patients with invasive epithelial ovarian cancer diagnosed in Ontario, Canada. Clinical information was obtained from medical records and prediagnostic exposure information was collected by telephone interview. Survival status was determined by linkage to the Ontario Cancer Registry. Proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for ovarian cancer-specific mortality associated with each exposure. Analyses were stratified by histologic subtype to further investigate the associations of risk factors on ovarian cancer-specific mortality.
After a mean follow-up of 9.48 years (range 0.59-20.32 years), 655 (46%) women had died of ovarian cancer. Parity (ever) was associated with a significant 29% decreased mortality risk compared with nulliparity (HR=0.71; 95% CI 0.54-0.93; P=0.01). There was a borderline significant association between ever use of oestrogen-containing hormone replacement therapy (HRT) and mortality (HR=0.79; 95% CI 0.62-1.01; P=0.06). A history of cigarette smoking was associated with a significant 25% increased risk of death compared with never smoking (HR=1.25; 95% CI 1.01-1.54; P=0.04). Women with a greater cumulative number of ovulatory cycles had a significantly decreased risk of ovarian cancer-specific death (HR=0.63; 95% CI 0.43-0.94; P=0.02). Increasing BMI (kg m) 5 years before diagnosis was associated with an increased risk of death (HR=1.17; 95% CI 1.07-1.28; P=0.0007). Other hormonal or lifestyle factors were not significantly associated with ovarian cancer-specific mortality.
Parity, ovulatory cycles, smoking, and BMI may affect survival following the diagnosis of ovarian cancer. Whether or not oestrogen-containing HRT use is beneficial for survival requires further evaluation.
多种流行病学因素已被证明会影响卵巢癌发生风险。鉴于该疾病具有较高的致死率，评估诊断前激素、生殖及生活方式暴露与卵巢癌特异性生存之间的关联具有重要意义。
我们纳入了1421例在加拿大安大略省被诊断为浸润性上皮性卵巢癌的患者。临床信息从病历中获取，诊断前暴露信息通过电话访谈收集。生存状态通过与安大略癌症登记处的数据关联来确定。采用比例风险回归来估计每种暴露与卵巢癌特异性死亡相关的风险比（HR）和95%置信区间（CI）。分析按组织学亚型分层，以进一步研究危险因素与卵巢癌特异性死亡之间的关联。
平均随访9.48年（范围0.59 - 20.32年）后，655例（46%）女性死于卵巢癌。与未生育相比，生育（曾经生育）与死亡风险显著降低29%相关（HR = 0.71；95% CI 0.54 - 0.93；P = 0.01）。曾经使用含雌激素的激素替代疗法（HRT）与死亡率之间存在边缘显著关联（HR = 0.79；95% CI 0.62 - 1.01；P = 0.06）。与从不吸烟相比，吸烟史与死亡风险显著增加25%相关（HR = 1.25；95% CI 1.01 - 1.54；P = 0.04）。排卵周期累计数较多的女性卵巢癌特异性死亡风险显著降低（HR = 0.63；95% CI 0.43 - 0.94；P = 0.02）。诊断前5年体重指数（BMI，kg/m²）增加与死亡风险增加相关（HR = 1.17；95% CI 1.07 - 1.28；P = 0.0007）。其他激素或生活方式因素与卵巢癌特异性死亡率无显著关联。
生育情况、排卵周期、吸烟和BMI可能影响卵巢癌诊断后的生存。含雌激素的HRT使用是否对生存有益需要进一步评估。
