Purpose:
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.
Methods:
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-, stage, and site-adjusted Cox proportional hazards
regression models, we estimated hazard ratios (HRs) and 95% confidence
intervals (CIs) associated with joint exposure to these factors.
Results:
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.
Conclusions:
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.