title: Diabetes mellitus and ovarian cancer: more complex than just increasing risk.
abstract: OBJECTIVE
  Diabetes mellitus (DM) is a risk factor for endometrial cancer and is associated with poorer outcomes in breast and colon cancers. This association is less clear in epithelial ovarian cancer (EOC). We sought to examine the effect of DM on progression-free (PFS) and overall survival (OS) in women with EOC.
  
  
  METHODS
  A retrospective cohort study of EOC patients diagnosed between 2004 and 2009 at a single institution was performed. Demographic, pathologic and DM diagnosis data were abstracted. Pearson chi-square test and t test were used to compare variables. The Kaplan-Meier method and the log rank test were used to compare PFS and OS between non-diabetic (ND) and DM patients.
  
  
  RESULTS
  62 (17%) of 367 patients had a diagnosis of DM. No differences in age, histology, debulking status, or administration of intraperitoneal chemotherapy between ND and DM patients were present, although there were more stage I and IV patients in the ND group (p=0.04). BMI was significantly different between the two groups (ND vs. DM, 27.5 vs. 30.7kg/m(2), p<0.001). While there were no differences in survival based on BMI, diabetic patients had a poorer PFS (10.3 vs. 16.3months, p=0.024) and OS (26.1 vs. 42.2months, p=0.005) compared to ND patients. Metformin use among diabetic patients did not appear to affect PFS or OS.
  
  
  CONCLUSIONS
  EOC patients with DM have poorer survival than patients without diabetes; this association is independent of obesity. Metformin use did not affect outcomes. The pathophysiology of this observation requires more inquiry.
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, United States. Electronic address: monjri@gmail.com.
authors.forename: Monjri M
authors.initials: MM
authors.lastname: Shah
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, United States.
authors.forename: Britt K
authors.initials: BK
authors.lastname: Erickson
authors.affiliation: School of Medicine, University of Alabama at Birmingham, United States.
authors.forename: Tasnia
authors.initials: T
authors.lastname: Matin
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, United States.
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, United States.
authors.forename: Jovana Y
authors.initials: JY
authors.lastname: Martin
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, United States.
authors.forename: Laura Becca
authors.initials: LB
authors.lastname: Daily
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pasko
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, United States.
authors.forename: Christen W
authors.initials: CW
authors.lastname: Haygood
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, United States.
authors.forename: Janelle M
authors.initials: JM
authors.lastname: Fauci
authors.affiliation: Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, United States.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Leath
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000150:complications / Q000401:mortality* / Q000628:therapy; D000368:Aged; D018269:Carcinoma, Endometrioid / Q000150:complications / Q000401:mortality* / Q000628:therapy; D000077216:Carcinoma, Ovarian Epithelial; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000150:complications / Q000401:mortality* / Q000628:therapy; D009765:Obesity / Q000150:complications*; D010051:Ovarian Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy; D011379:Prognosis
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
keywords: Body mass index; Diabetes; Outcomes; Ovarian cancer