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Background Parity is associated with decreased risk of invasive ovarian cancer; however, the relationship between incomplete pregnancies and invasive ovarian cancer risk is unclear. This relationship was examined using 15 case-control studies from the Ovarian Cancer Association Consortium (OCAC). Histotype-specific associations, which have not been examined previously with large sample sizes, were also evaluated. Methods A pooled analysis of 10,470 invasive epithelial ovarian cancer cases and 16,942 controls was conducted. Odds ratios and 95% confidence intervals for the association between incomplete pregnancies and invasive epithelial ovarian cancer were estimated using logistic regression. All models were conditioned on OCAC study, race/ethnicity, age, and education level, and adjusted for number of complete pregnancies, oral contraceptive use, and history of breastfeeding. The same approach was used for histotype-specific analyses. Results Ever having an incomplete pregnancy was associated with a 16% reduction in ovarian cancer risk (OR = 0.84, 95% CI = 0.79 to 0.89). There was a trend of decreasing risk with increasing number of incomplete pregnancies (two-sided Ptrend <.001). An inverse association was observed for all major histotypes; it was strongest for clear cell ovarian cancer. Conclusions Incomplete pregnancies are associated with a reduced risk of invasive epithelial ovarian cancer. Pregnancy, including incomplete pregnancy, was associated with a greater reduction in risk of clear cell ovarian cancer, but the result was broadly consistent across histotypes. Future work should focus on understanding the mechanisms underlying this reduced risk.

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Background: There is suggestive evidence that inflammation is related to ovarian cancer survival. However, more research is needed to identify inflammation-related factors that are associated with ovarian cancer survival and to determine their combined effects.Methods: This analysis used pooled data on 8,147 women with invasive epithelial ovarian cancer from the Ovarian Cancer Association Consortium. The prediagnosis inflammation-related exposures of interest included alcohol use; aspirin use; other nonsteroidal anti-inflammatory drug use; body mass index; environmental tobacco smoke exposure; history of pelvic inflammatory disease, polycystic ovarian syndrome, and endometriosis; menopausal hormone therapy use; physical inactivity; smoking status; and talc use. Using Cox proportional hazards models, the relationship between each exposure and survival was assessed in 50% of the data. A weighted inflammation-related risk score (IRRS) was developed, and its association with survival was assessed using Cox proportional hazards models in the remaining 50% of the data.Results: There was a statistically significant trend of increasing risk of death per quartile of the IRRS [HR ¼ 1.09; 95% confidence interval (CI), 1.03-1.14]. Women in the upper quartile of the IRRS had a 31% higher death rate compared with the lowest quartile (95% CI, 1.11-1.54).Conclusions: A higher prediagnosis IRRS was associated with an increased mortality risk after an ovarian cancer diagnosis. Further investigation is warranted to evaluate whether postdiagnosis exposures are also associated with survival.Impact: Given that pre-and postdiagnosis exposures are often correlated and many are modifiable, our study results can ultimately motivate the development of behavioral recommendations to enhance survival among patients with ovarian cancer.

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Introduction Although most women with high-grade serous ovarian cancer (HGSC) die within five years, approximately 15% will survive for 10 or more years. The factors contributing to this exceptional survival are currently unknown, but are thought to be a complex interaction between clinical, genetic, immunologic, and lifestyle factors. The purpose of this study is to qualitatively explore factors that may influence exceptional ovarian cancer survival. Methodological Approach Four focus groups, one each in Los Angeles (California), Ann Arbor (Michigan), New York (New York) and Edmonton (Alberta, Canada), were conducted. Women previously diagnosed with HGSC who have survived 5 or more years were invited to participate. Physical activity, diet, meditation, prayer, treatment, integrative medicine, and side effects were explored in the semi-structured focus group interviews. All four sessions were audiotaped and transcribed. The transcriptions were coded by two individuals using grounded theory. The coded transcripts were analyzed using Dedoose. Findings Of the 26 women who participated, 24 were diagnosed with HGSC. Two women, one with a stage III, low-grade mucinous tumor and another with a MMMT carcinosarcoma, did not meet our inclusion criteria, but were not asked to leave. Among the 24 women with HGSC, 19 have survived 10 or more years, two 8-9 years and three 5-7 years; all but one woman had stage III or IV disease. Three overarching themes were uncovered: (a) Survivors were highly motivated to improve lifestyle factors, including but not limited to fitness and diet, and had, in fact, done so; (b) Survivors had a strong life purpose, which manifested as positivity, taking charge, and self-advocacy; and (c) Survivors were able to draw on strong support systems, which included family, friends, support groups, faith, and healthcare workers. Conclusion HGSC long-term survivors have varying experiences with their cancer, but share motivation and persistence, strong life purpose, and strong support systems. This study sheds light on how the specific behaviors and attitudes of patients may contribute to their long-term survival with HGSC. Focus groups are preparatory to further prospective studies that will determine whether short term and long term survivors differ on these characteristics. Our results highlight the need for more research to gain better understanding of the role that life purpose and support systems play in survival with HGSC. Citation Format: Aliya Alimujiang, Lilah Khoja, Ashley Wiensch, Malcolm C. Pike, Penelope Webb, Anne Chase, Jean Richardson, Celeste Leigh Pearce. Ovarian cancer survivors' views of factors that influenced their exceptional survival: A qualitative study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3288.

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