Article
Cigarette smoking is associated with adverse survival among women with ovarian cancer: Results from a pooled analysis of 19 studies
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- (1) Virus, Lifestyle and Genes Danish Cancer Society Research Center Copenhagen Denmark
- (2) Statistics, Bioinformatics and Registry Danish Cancer Society Research Center Copenhagen Denmark
- (3) QIMR Berghofer Medical Research Institute, grid.1049.c
- (4) University of Sydney, grid.1013.3
- (5) Westmead Hospital, grid.413252.3
- (6) University of Copenhagen, grid.5254.6, KU
- (7) University of Washington, grid.34477.33
- (8) Program in Epidemiology, Division of Public Health Sciences Fred Hutchinson Cancer Research Center Seattle WA
- (9) Department of Epidemiology, The Geisel School of Medicine Dartmouth College Hanover NH
- (10) Cancer Prevention and Control Samuel Oschin Comprehensive Cancer Institute, Cedars‐Sinai Medical Center Los Angeles CA
- (11) Community and Population Health Research Institute, Department of Biomedical Sciences Cedars‐Sinai Medical Center Los Angeles CA
- (12) Department of Epidemiology University of Pittsburgh Graduate School of Public Health Pittsburgh PA
- (13) Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology University of Pittsburgh School of Medicine Pittsburgh PA
- (14) Ovarian Cancer Center of Excellence, Womens Cancer Research Program, Magee‐Womens Research Institute and University of Pittsburgh Cancer Institute Pittsburgh PA
- (15) Department of Cancer Prevention and Control Roswell Park Cancer Institute Buffalo NY
- (16) School of Public Health The University of Texas Houston TX
- (17) Division of Molecular Medicine Aichi Cancer Center Research Institute Nagoya Aichi Japan
- (18) Aichi Cancer Center, grid.410800.d
- (19) Department of Health Science Research, Division of Epidemiology Mayo Clinic Rochester MN
- (20) Department of Health Science Research, Division of Biomedical Statistics and Informatics Mayo Clinic Rochester MN
- (21) University of Kansas Medical Center Kansas City KS
- (22) Department of Epidemiology Harvard T. H. Chan School of Public Health Boston MA
- (23) Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital Boston MA
- (24) Department of Public Health Science, School of Medicine University of Virginia Charlottesville VA
- (25) Department of Obstetrics and Gynecology Duke University Medical Center Durham NC
- (26) Cancer Prevention and Control Program Rutgers Cancer Institute of New Jersey New Brunswick NJ
- (27) Rutgers School of Public Health Piscataway NJ
- (28) New Jersey Department of Health and Senior Services Trenton NJ
- (29) School of Public Health University of Medicine and Dentistry of New Jersey Piscataway NJ
- (30) Department of Gynaecology Radboud University Medical Center, Radboud Institute for Molecular Life Sciences Nijmegen The Netherlands
- (31) Division of Cancer Epidemiology and Genetics National Cancer Institute Bethesda MD
- (32) Department of Oncology, Department of Public Health and Primary Care University of Cambridge, Strangeways Research laboratory Cambridge United Kingdom
- (33) Departments of Health Research & Policy and of Biomedical Data Science Stanford School of Medicine Stanford CA
- (34) Department of Health Research and Policy ‐ Epidemiology Stanford University School of Medicine Stanford CA
- (35) Departments of Population Health Science & Policy and of Genetics & Genomic Sciences Icahn School of Medicine at Mount Sinai New York NY
- (36) Department of Epidemiology Center for Cancer Genetics Research & Prevention, School of Medicine, University of California Irvine Irvine CA
- (37) Department of Epidemiology University of California Irvine Irvine CA
- (38) Women's Cancer, Institute for Women's Health, University College London London United Kingdom
- (39) Center for Cancer Prevention and Translational Genomics, Samuel Oschin Comprehensive Cancer Institute, Cedars‐Sinai Medical Center Los Angeles CA
- (40) Department of Biomedical Sciences Cedars‐Sinai Medical Center Los Angeles CA
- (41) The Kinghorn Cancer Centre, Garvan Institute of Medical Research Darlinghurst NSW Australia
- (42) UNSW Sydney, grid.1005.4
- (43) Department of Preventive Medicine, Keck School of Medicine University of Southern California Norris Comprehensive Cancer Center Los Angeles CA
- (44) Department of Epidemiology University of Michigan School of Public Health Ann Arbor MI
- (45) Department of Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Center New York NY
- (46) Department of Health Science California State University Fullerton CA
- (47) Epidemiology Center, College of Medicine University of South Florida Tampa FL
- (48) German Cancer Research Center, grid.7497.d
- (49) University Cancer Center Hamburg (UCCH), University Medical Center Hamburg‐Eppendorf Hamburg Germany
- (50) Department of Chronic Disease Epidemiology Yale School of Public Health New Haven CT
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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.
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