Article open access publication

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

International Journal of Cancer, Wiley, ISSN 0020-7136

Volume 140, 11, 2017

DOI:10.1002/ijc.30600, Dimensions: pub.1034537648, PMC: PMC5489656, PMID: 28063166,



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


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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