Cigarette smoking is associated with adverse survival among women with ovarian cancer: Results from a pooled analysis of 19 studies

Abstract

Cigarette smoking is associated with an increased risk of developing mucinous ovarian tumors but whether it is associated with ovarian cancer survival overall or for the different histotypes is unestablished. Furthermore, it is unknown whether the association between cigarette smoking and survival differs according to strata of ovarian cancer stage at diagnosis. In a large pooled analysis, we evaluated the association between various measures of cigarette smoking and survival among women with epithelial ovarian cancer. We obtained data from 19 case-control studies in the Ovarian Cancer Association Consortium (OCAC), including 9,114 women diagnosed with ovarian cancer. Cox regression models were used to estimate adjusted study-specific hazard ratios (HRs), which were combined into pooled hazard ratios (pHR) with corresponding 95% confidence intervals (CIs) under random effects models. Overall, 5,149 (57%) women died during a median follow-up period of 7.0 years. Among women diagnosed with ovarian cancer, both current (pHR = 1.17, 95% CI: 1.08–1.28) and former smokers (pHR = 1.10, 95% CI: 1.02–1.18) had worse survival compared with never smoking women. In histotype-stratified analyses, associations were observed for mucinous (current smoking: pHR = 1.91, 95% CI: 1.01–3.65) and serous histotypes (current smoking: pHR = 1.11, 95% CI: 1.00–1.23; former smoking: pHR = 1.12, 95% CI: 1.04–1.20). Further, our results suggested that current smoking has a greater impact on survival among women with localized than disseminated disease. The identification of cigarette smoking as a modifiable factor associated with survival has potential clinical importance as a focus area to improve ovarian cancer prognosis.

Ovarian cancer risk factors by tumor aggressiveness: An analysis from the Ovarian Cancer Cohort Consortium

“…Furthermore, limited data suggest that smoking may impact the effectiveness of neoadjuvant therapy, 47 particularly for mucinous tumors. This is in agreement with observed differences between smoking and ovarian cancer mortality by histology in OCAC, 46 with the strongest associations between smoking and mortality observed for mucinous disease. We observed similar associations in serous and endometrioid/clear cell subgroups in the current study; case numbers precluded evaluating smoking by aggressiveness among mucinous cases.…”

Prediagnosis and postdiagnosis smoking and survival following diagnosis with ovarian cancer

“…Smoking may enhance the invasive potential of cancer cells, increase the risk of cancer recurrence and development of second primary cancers, alter cancer drug metabolism and promote the development of thrombosis, which are all associated with an increased risk of mortality. Current smoking prior to or at diagnosis was related to worse outcomes of ovarian cancer patients in four out of five prior studies, although mixed results were noted for smoking rate, accumulative pack‐years and duration since quitting in the few studies that assessed these associations . Due to limited sample sizes, most of these studies were not able to evaluate associations by histologic subtype, which have very different outcomes.…”

“…Due to limited sample sizes, most of these studies were not able to evaluate associations by histologic subtype, which have very different outcomes. Although many cancer survivors continue smoking after diagnosis, few studies have examined the impact of postdiagnosis smoking on ovarian cancer survival, which may result in decreased survival time due to reduced treatment effectiveness, worse side effects of treatment and increased risk of a second malignancy …”

Is Ovarian Cancer Prevention Currently Still a recommendation of Our Grandparents?

“…Furthermore, cigarette was found to be a modifiable factor associated with survival and it improved disease prognosis. 59 Alcohol consumption increases serum and urinary concentrations of androgens, estrogen, and other sex hormones, and it has been widely associated with an increased incidence of breast cancer. 60 Epidemiological studies have also reported a direct correlation between alcohol consumption and an increased risk of developing ovarian cancer, and this correlation is dependent on the amount and duration of exposure (chronic versus acute exposure).…”