Minlikeeva Albina N, Cannioto Rikki, Jensen Allan, Kjaer Susanne K, Jordan Susan J, Diergaarde Brenda, Szender J Brian, Odunsi Kunle, Almohanna Hani, Mayor Paul, Starbuck Kirsten, Zsiros Emese, Bandera Elisa V, Cramer Daniel W, Doherty Jennifer A, DeFazio Anna, Edwards Robert, Goode Ellen L, Goodman Marc T, Høgdall Estrid, Matsuo Keitary, Mizuno Mika, Nagle Christina M, Ness Roberta B, Paddock Lisa E, Pearce Celeste L, Risch Harvey A, Rossing Mary Anne, Terry Kathryn L, Wu Anna H, Modugno Francesmary, Webb Penelope M, Moysich Kirsten B
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.
Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
Cancer Causes Control. 2019 May;30(5):537-547. doi: 10.1007/s10552-019-01157-3. Epub 2019 Mar 23.
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.
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.
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.
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.
以往的流行病学研究表明，吸烟、肥胖和缺乏体育锻炼与卵巢癌诊断后的不良生存情况相关。然而，这些不良生活方式因素对卵巢癌生存的综合关系尚未得到充分研究。
利用从13项研究中汇总的数据，我们研究了吸烟、超重/肥胖和缺乏体育锻炼的综合暴露与确诊为浸润性上皮性卵巢癌的女性（n = 7,022）的总生存期（OS）以及无进展生存期（PFS）之间的关联。使用年龄和分期调整的Cox比例风险回归模型，我们估计了与这些因素联合暴露相关的风险比（HRs）和95%置信区间（CIs）。
与从不吸烟、体重指数（BMI）正常且积极锻炼的女性相比，诊断前同时暴露于当前吸烟、超重/肥胖和缺乏体育锻炼与死亡风险显著增加相关（HR = 1.37；95% CI 1.10 - 1.70）。这些因素联合暴露的关联超过了每种暴露单独的关联。事实上，同时暴露于当前吸烟和超重/肥胖以及当前吸烟和缺乏体育锻炼也与死亡风险增加相关（HR分别为1.28；95% CI 1.08 - 1.52和HR = 1.26；95% CI 1.04 - 1.54）。当评估既往吸烟与其他暴露的组合以及将超重仅限于肥胖时，关联程度相似。在这些因素的任何联合暴露与PFS之间未观察到显著关联。
吸烟、超重和缺乏体育锻炼的联合暴露可能对卵巢癌患者的生存产生负面影响。这些结果表明了研究生活方式因素对卵巢癌患者生存的综合影响的重要性。
