Impact of Pre-Diagnostic Risk Factors on Short- and Long-Term Ovarian Cancer Survival Trajectories: A Longitudinal Observational Study

Author:

Kim Shana J.12ORCID,Tworoger Shelley S.3,Rosen Barry P.45,McLaughlin John R.67,Risch Harvey A.8,Narod Steven A.12ORCID,Kotsopoulos Joanne12

Affiliation:

1. Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5S 1B2, Canada

2. Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada

3. Division of Oncological Sciences, Knight Cancer Institute, Oregon Health and Sciences, Portland, OR 97201, USA

4. Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C4, Canada

5. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada

6. Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada

7. Public Health Ontario, Toronto, ON M5G 1M1, Canada

8. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06520, USA

Abstract

Tumor- and treatment-related factors are established predictors of ovarian cancer survival. New studies suggest a differential impact of exposures on ovarian cancer survival trajectories (i.e., rapidly fatal to long-term disease). This study examined the impact of pre-diagnostic risk factors on short- and long-term ovarian cancer survival trajectories in the Canadian context. This population-based longitudinal observational study included women diagnosed with invasive epithelial ovarian cancer from 1995 to 2004 in Ontario. Data were obtained from medical records, interviews, and the provincial cancer registry. Extended Cox proportional hazard models estimated the association between risk factors and all-cause and ovarian cancer-specific mortality by survival time intervals (<3 years (i.e., short-term survival), 3 to <6 years, 6 to <10 years, and ≥10 years (i.e., long-term survival)). Among 1421 women, histology, stage, and residual disease were the most important predictors of all-cause mortality in all survival trajectories, particularly for short-term survival. Reproductive and lifestyle factors did not strongly impact short-term overall survival but were associated with long-term overall survival. As such, among long-term survivors, history of breastfeeding significantly decreased the risk of all-cause mortality (HR 0.65; 95% CI 0.46, 0.93; p < 0.05), whereas smoking history (HR 1.75; 95% CI 1.27, 2.40; p < 0.05) and obesity (HR 1.81; 95% CI 1.24, 2.65; p < 0.05) significantly increased the risk of all-cause mortality. The findings were consistent with ovarian cancer-specific mortality. These findings suggest that pre-diagnostic exposures differentially influence survival time following a diagnosis of ovarian cancer.

Funder

US National Institutes of Health

Peter Gilgan Center for Women’s Cancers at Women’s College Hospital

Canadian Cancer Society Research

Publisher

MDPI AG

Reference30 articles.

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