title: Smoking and overweight: negative prognostic factors in stage III epithelial ovarian cancer.
abstract: OBJECTIVE
  Smoking and overweight are associated with poorer prognosis in several cancer types. The prognostic effect of smoking and body mass index (BMI) on ovarian cancer is unknown.
  
  
  METHODS
  Ovarian cancer cases were from the Danish MALOVA (MALignant OVArian cancer) study. Information on smoking status and BMI was obtained from a personal interview conducted closely after primary surgery. Cox regression models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for ovarian cancer-specific death in relation to smoking variables and BMI.
  
  
  RESULTS
  A total of 295 women with stage III epithelial ovarian cancer were identified and followed to death or for a median of 7.3 years (range, 5.4-9.5 years). Median survival time for normal-weight never smokers was 2.8 years (95% CI, 2.3-3.2) compared with 1.2 years (95% CI, 0.8-2.3) for overweight current smokers. Current smokers had a significantly increased risk of ovarian cancer death compared with never smokers in multivariate Cox analysis (HR, 1.65; 95% CI, 1.22-2.24). The negative effect of smoking diminished with increasing time since a former smoker had stopped smoking (HR, 0.89; 95% CI, 0.80-0.98 per 5 years since stop of smoking). Overweight women also had an increased risk of ovarian cancer death (HR, 1.83; 95% CI, 1.38-2.42) compared with normal-weight women.
  
  
  CONCLUSIONS
  Smoking at the time of diagnosis and premorbid overweight were negative prognostic factors for ovarian cancer-specific survival. The negative effect of smoking decreased with increasing time since stop of smoking.
authors.affiliation: Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen.
authors.forename: Anette
authors.initials: A
authors.lastname: Kjaerbye-Thygesen
authors.forename: Kirsten
authors.initials: K
authors.lastname: Frederiksen
authors.forename: Estrid V
authors.initials: EV
authors.lastname: Høgdall
authors.forename: Eva
authors.initials: E
authors.lastname: Glud
authors.forename: Lise
authors.initials: L
authors.lastname: Christensen
authors.forename: Claus K
authors.initials: CK
authors.lastname: Høgdall
authors.forename: Jan
authors.initials: J
authors.lastname: Blaakaer
authors.forename: Susanne K
authors.initials: SK
authors.lastname: Kjaer
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002277:Carcinoma / Q000453:epidemiology* / Q000401:mortality; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications*; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D012907:Smoking / Q000009:adverse effects*; D016019:Survival Analysis