History of hypertension, heart disease, and diabetes and ovarian cancer patient survival: evidence from the ovarian cancer association consortium.
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Minlikeeva Albina N, Freudenheim Jo L, Cannioto Rikki A, Szender J Brian, Eng Kevin H, Modugno Francesmary, Ness Roberta B, LaMonte Michael J, Friel Grace, Segal Brahm H, Odunsi Kunle, Mayor Paul, Zsiros Emese, Schmalfeldt Barbara, Klapdor Rüdiger, Dӧrk Thilo, Hillemanns Peter, Kelemen Linda E, Kӧbel Martin, Steed Helen, de Fazio Anna, Australian Ovarian Cancer Study Group, Jordan Susan J, Nagle Christina M, Risch Harvey A, Rossing Mary Anne, Doherty Jennifer A, Goodman Marc T, Edwards Robert, Matsuo Keitaro, Mizuno Mika, Karlan Beth Y, Kjær Susanne K, Høgdall Estrid, Jensen Allan, Schildkraut Joellen M, Terry Kathryn L, Cramer Daniel W, Bandera Elisa V, Paddock Lisa E, Kiemeney Lambertus A, Massuger Leon F, Kupryjanczyk Jolanta, Berchuck Andrew, Chang-Claude Jenny, Diergaarde Brenda, Webb Penelope M, Moysich Kirsten B, Ovarian Cancer Association Consortium
Аннотация
METHODS: Using pooled data from fifteen studies participating in the Ovarian Cancer Association Consortium, we examined the associations between history of hypertension, heart disease, diabetes, and medications taken for these conditions and overall survival (OS) and progression-free survival (PFS) among patients diagnosed with invasive epithelial ovarian carcinoma. We used Cox proportional hazards regression models adjusted for age and stage to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) overall and within strata of histological subtypes.
RESULTS: History of diabetes was associated with increased risk of mortality (n = 7,674; HR = 1.12; 95% CI = 1.01-1.25). No significant mortality associations were observed for hypertension (n = 6,482; HR = 0.95; 95% CI = 0.88-1.02) or heart disease (n = 4,252; HR = 1.05; 95% CI = 0.87-1.27). No association of these comorbidities was found with PFS in the overall study population. However, among patients with endometrioid tumors, hypertension was associated with lower risk of progression (n = 339, HR = 0.54; 95% CI = 0.35-0.84). Comorbidity was not associated with OS or PFS for any of the other histological subtypes. Ever use of beta blockers, oral antidiabetic medications, and insulin was associated with increased mortality, HR = 1.20; 95% CI = 1.03-1.40, HR = 1.28; 95% CI = 1.05-1.55, and HR = 1.63; 95% CI = 1.20-2.20, respectively. Ever use of diuretics was inversely associated with mortality, HR = 0.71; 95% CI = 0.53-0.94.
CONCLUSIONS: Histories of hypertension, diabetes, and use of diuretics, beta blockers, insulin, and oral antidiabetic medications may influence the survival of ovarian cancer patients. Understanding mechanisms for these observations could provide insight regarding treatment.