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Obesity and survival among women with ovarian cancer: results from the Ovarian Cancer Association Consortium

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Observational studies have reported a modest association between obesity and risk of ovarian cancer; however, whether it is also associated with survival and whether this association varies for the different histologic subtypes are not clear. We undertook an international collaborative analysis to assess the association between body mass index (BMI), assessed shortly before diagnosis, progression-free survival (PFS), ovarian cancer-specific survival and overall survival (OS) among women with invasive ovarian cancer.

Methods:: We used original data from 21 studies, which included 12 390 women with ovarian carcinoma. We combined study-specific adjusted hazard ratios (HRs) using random-effects models to estimate pooled HRs (pHR). We further explored associations by histologic subtype.

Results:: Overall, 6715 (54%) deaths occurred during follow-up. A significant OS disadvantage was observed for women who were obese (BMI: 30–34.9, pHR: 1.10 (95% confidence intervals (CIs): 0.99–1.23); BMI: ⩾35, pHR: 1.12 (95% CI: 1.01–1.25)). Results were similar for PFS and ovarian cancer-specific survival. In analyses stratified by histologic subtype, associations were strongest for women with low-grade serous (pHR: 1.12 per 5 kg m−2) and endometrioid subtypes (pHR: 1.08 per 5 kg m−2), and more modest for the high-grade serous (pHR: 1.04 per 5 kg m−2) subtype, but only the association with high-grade serous cancers was significant.

Conclusions:: Higher BMI is associated with adverse survival among the majority of women with ovarian cancer.

No MeSH data available.


Related in: MedlinePlus

The association between BMI (per 5 kg m−2) and OS following a diagnosis of invasive ovarian cancer, by histologic subtype, two-stage pooled analysis. Pooled HR combined study site-specific estimates adjusting for age at diagnosis (continuous), stage (local/regional/distant/unknown), grade (well-/moderately-/poorly plus undifferentiated/unknown) (except for low- and high-grade serous estimates) and ethnicity (if <95% of participants at a site shared a common ethnicity) estimates are further adjusted for the interaction of age, stage, grade and/or race with time as appropriate at each site. Excludes participants with BMI <18.5 kg m−2. Includes study sites with adequate numbers of cases and events to generate an estimate for each histologic group. Pooled HR for serous, mucinous, endometrioid and clear-cell includes study sites: AUS, BAV, CON, DOV, HAW, HOP, MAL, NCO, NEC, STA, TBO and USC. Pooled HR for serous low-grade and serous high-grade includes study sites: AUS, BAV, BEL, DOV, HOP, MAL, NCO, NEC, NJO, STA, UCI and USC.
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fig3: The association between BMI (per 5 kg m−2) and OS following a diagnosis of invasive ovarian cancer, by histologic subtype, two-stage pooled analysis. Pooled HR combined study site-specific estimates adjusting for age at diagnosis (continuous), stage (local/regional/distant/unknown), grade (well-/moderately-/poorly plus undifferentiated/unknown) (except for low- and high-grade serous estimates) and ethnicity (if <95% of participants at a site shared a common ethnicity) estimates are further adjusted for the interaction of age, stage, grade and/or race with time as appropriate at each site. Excludes participants with BMI <18.5 kg m−2. Includes study sites with adequate numbers of cases and events to generate an estimate for each histologic group. Pooled HR for serous, mucinous, endometrioid and clear-cell includes study sites: AUS, BAV, CON, DOV, HAW, HOP, MAL, NCO, NEC, STA, TBO and USC. Pooled HR for serous low-grade and serous high-grade includes study sites: AUS, BAV, BEL, DOV, HOP, MAL, NCO, NEC, NJO, STA, UCI and USC.

Mentions: The results stratified by histologic subtype are shown in Figure 3. This analysis included only the 12 studies with adequate numbers of cases and events to generate estimates for each histologic subtype. The strongest associations were seen for the low-grade serous and endometrioid subtypes, but neither result was significant (pHR: 1.12 (95% CIs: 0.96–1.31) and 1.08 (95% CIs: 0.95–1.23), respectively, per 5-unit increase in BMI). A more modest but significant association was observed for the high-grade serous subtype (pHR per 5-unit increase in BMI: 1.04 (95% CIs: 1.00–1.09)). No association was noted between BMI and survival among women with mucinous or clear cell tumours. Tests for heterogeneity (between the four main subtypes and for low- vs high-grade serous subtypes) did not reach statistical significance (both P=1.0).


Obesity and survival among women with ovarian cancer: results from the Ovarian Cancer Association Consortium
The association between BMI (per 5 kg m−2) and OS following a diagnosis of invasive ovarian cancer, by histologic subtype, two-stage pooled analysis. Pooled HR combined study site-specific estimates adjusting for age at diagnosis (continuous), stage (local/regional/distant/unknown), grade (well-/moderately-/poorly plus undifferentiated/unknown) (except for low- and high-grade serous estimates) and ethnicity (if <95% of participants at a site shared a common ethnicity) estimates are further adjusted for the interaction of age, stage, grade and/or race with time as appropriate at each site. Excludes participants with BMI <18.5 kg m−2. Includes study sites with adequate numbers of cases and events to generate an estimate for each histologic group. Pooled HR for serous, mucinous, endometrioid and clear-cell includes study sites: AUS, BAV, CON, DOV, HAW, HOP, MAL, NCO, NEC, STA, TBO and USC. Pooled HR for serous low-grade and serous high-grade includes study sites: AUS, BAV, BEL, DOV, HOP, MAL, NCO, NEC, NJO, STA, UCI and USC.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4559823&req=5

fig3: The association between BMI (per 5 kg m−2) and OS following a diagnosis of invasive ovarian cancer, by histologic subtype, two-stage pooled analysis. Pooled HR combined study site-specific estimates adjusting for age at diagnosis (continuous), stage (local/regional/distant/unknown), grade (well-/moderately-/poorly plus undifferentiated/unknown) (except for low- and high-grade serous estimates) and ethnicity (if <95% of participants at a site shared a common ethnicity) estimates are further adjusted for the interaction of age, stage, grade and/or race with time as appropriate at each site. Excludes participants with BMI <18.5 kg m−2. Includes study sites with adequate numbers of cases and events to generate an estimate for each histologic group. Pooled HR for serous, mucinous, endometrioid and clear-cell includes study sites: AUS, BAV, CON, DOV, HAW, HOP, MAL, NCO, NEC, STA, TBO and USC. Pooled HR for serous low-grade and serous high-grade includes study sites: AUS, BAV, BEL, DOV, HOP, MAL, NCO, NEC, NJO, STA, UCI and USC.
Mentions: The results stratified by histologic subtype are shown in Figure 3. This analysis included only the 12 studies with adequate numbers of cases and events to generate estimates for each histologic subtype. The strongest associations were seen for the low-grade serous and endometrioid subtypes, but neither result was significant (pHR: 1.12 (95% CIs: 0.96–1.31) and 1.08 (95% CIs: 0.95–1.23), respectively, per 5-unit increase in BMI). A more modest but significant association was observed for the high-grade serous subtype (pHR per 5-unit increase in BMI: 1.04 (95% CIs: 1.00–1.09)). No association was noted between BMI and survival among women with mucinous or clear cell tumours. Tests for heterogeneity (between the four main subtypes and for low- vs high-grade serous subtypes) did not reach statistical significance (both P=1.0).

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Observational studies have reported a modest association between obesity and risk of ovarian cancer; however, whether it is also associated with survival and whether this association varies for the different histologic subtypes are not clear. We undertook an international collaborative analysis to assess the association between body mass index (BMI), assessed shortly before diagnosis, progression-free survival (PFS), ovarian cancer-specific survival and overall survival (OS) among women with invasive ovarian cancer.

Methods:: We used original data from 21 studies, which included 12&thinsp;390 women with ovarian carcinoma. We combined study-specific adjusted hazard ratios (HRs) using random-effects models to estimate pooled HRs (pHR). We further explored associations by histologic subtype.

Results:: Overall, 6715 (54%) deaths occurred during follow-up. A significant OS disadvantage was observed for women who were obese (BMI: 30&ndash;34.9, pHR: 1.10 (95% confidence intervals (CIs): 0.99&ndash;1.23); BMI: &#10878;35, pHR: 1.12 (95% CI: 1.01&ndash;1.25)). Results were similar for PFS and ovarian cancer-specific survival. In analyses stratified by histologic subtype, associations were strongest for women with low-grade serous (pHR: 1.12 per 5&thinsp;kg&thinsp;m&minus;2) and endometrioid subtypes (pHR: 1.08 per 5&thinsp;kg&thinsp;m&minus;2), and more modest for the high-grade serous (pHR: 1.04 per 5&thinsp;kg&thinsp;m&minus;2) subtype, but only the association with high-grade serous cancers was significant.

Conclusions:: Higher BMI is associated with adverse survival among the majority of women with ovarian cancer.

No MeSH data available.


Related in: MedlinePlus