title: Diurnal cortisol and survival in epithelial ovarian cancer.
abstract: BACKGROUND
  Hypothalamic-pituitary-adrenal (HPA) deregulation is commonly observed in cancer patients, but its clinical significance is not well understood. We prospectively examined the association between HPA activity, tumor-associated inflammation, and survival in ovarian cancer patients prior to treatment.
  
  
  METHODS
  Participants were 113 women with ovarian cancer who provided salivary cortisol for three days prior to treatment for calculation of cortisol slope, variability, and night cortisol. Cox proportional hazard regression analyses were used to examine associations between cortisol and survival in models adjusting for disease stage, tumor grade, cytoreduction and age. On a subsample of 41 patients with advanced disease ascites fluid was assayed for levels of interleukin-6 (IL-6) and correlated with cortisol variables.
  
  
  RESULTS
  Each cortisol measure was associated with decreased survival time, adjusting for covariates (all p<.041). A one standard deviation increase in night cortisol was associated with a 46% greater likelihood of death. Patients in the high night cortisol group survived an estimated average of 3.3 years compared to 7.3 years for those in the low night cortisol group. Elevated ascites IL-6 was associated with each cortisol measure (all r>36, all p<.017).
  
  
  CONCLUSIONS
  Abnormal cortisol rhythms assessed prior to treatment are associated with decreased survival in ovarian cancer and increased inflammation in the vicinity of the tumor. HPA abnormalities may reflect poor endogenous control of inflammation, dysregulation caused by tumor-associated inflammation, broad circadian disruption, or some combination of these factors. Nocturnal cortisol may have utility as a non-invasive measure of HPA function and/or disease severity.
authors: Department of Psychology, University of Iowa, E11 Seashore Hall, Iowa City, IA 52242, USA. Electronic address: Andrew-schrepf@uiowa.edu.
authors: Andrew
authors: A
authors: Schrepf
authors: Division of Gynecologic Oncology, Washington University School of Medicine, Maternity Building-660 South Euclid, Campus Box 8064, St. Louis, MO 63110, USA. Electronic address: thakerp@wudosis.wustl.edu.
authors: Premal H
authors: PH
authors: Thaker
authors: Department of Obstetrics and Gynecology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA; Department of Anatomy and Cell Biology, University of Iowa, USA. Electronic address: michael-goodheart@uiowa.edu.
authors: Michael J
authors: MJ
authors: Goodheart
authors: Department of Obstetrics and Gynecology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA. Electronic address: david-bender@uiowa.edu.
authors: David
authors: D
authors: Bender
authors: Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, 300 Medical Plaza Driveway, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA. Electronic address: GSlavich@mednet.ucla.edu.
authors: George M
authors: GM
authors: Slavich
authors: Department of Urology, University of Iowa, 3 Roy Carver Pavilion, 200 Hawkins Dr, Iowa City, IA 52242, USA; Department of Pathology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA. Electronic address: laila-dahmoush@uiowa.edu.
authors: Laila
authors: L
authors: Dahmoush
authors: Department of Medical Social Sciences, Northwestern University, 633 N. Saint Clair St., 19th Floor, Chicago, IL 60611, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, 446 East Ontario, #7-200, Chicago, IL 60611, USA. Electronic address: fpenedo@northwestern.edu.
authors: Frank
authors: F
authors: Penedo
authors: Division of Gynecologic Oncology, Oregon Health & Science University, Center for Women's Health, Kohler Pavilion, 7th Floor, 808 S.W. Campus Drive, Portland, OR 97239, USA.
authors: Koen
authors: K
authors: DeGeest
authors: Department of Obstetrics and Gynecology, Florida International University School of Medicine, 5000 University Dr, Coral Gables, FL 33146, USA. Electronic address: lemendez@comcast.net.
authors: Luis
authors: L
authors: Mendez
authors: Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA; Department of Microbiology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA; Holden Comprehensive Cancer Center, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA. Electronic address: David-lubaroff@uiowa.edu.
authors: David M
authors: DM
authors: Lubaroff
authors: Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, 300 Medical Plaza Driveway, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA; Department of Medicine, UCLA School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA. Electronic address: coles@ucla.edu.
authors: Steven W
authors: SW
authors: Cole
authors: Department of Gynecologic Oncology, UT MD Anderson Comprehensive Cancer Center, 1155 Herman Pressler, Unit Number: 1362, Houston, TX 77030, USA; Department of Cancer Biology, UT MD Anderson Comprehensive Cancer Center, 1155 Herman Pressler, Unit Number: 1362, Houston, TX 77030, USA. Electronic address: asood@mdanderson.org.
authors: Anil K
authors: AK
authors: Sood
authors: Department of Psychology, University of Iowa, E11 Seashore Hall, Iowa City, IA 52242, USA; Department of Obstetrics and Gynecology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA; Department of Urology, University of Iowa, 3 Roy Carver Pavilion, 200 Hawkins Dr, Iowa City, IA 52242, USA; Holden Comprehensive Cancer Center, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA. Electronic address: susan-lutgendorf@uiowa.edu.
authors: Susan K
authors: SK
authors: Lutgendorf
mesh_terms: D000368:Aged; D001202:Ascitic Fluid / Q000276:immunology; D000077216:Carcinoma, Ovarian Epithelial; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000276:immunology / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism*; D007249:Inflammation / Q000276:immunology / Q000378:metabolism; D015850:Interleukin-6 / Q000276:immunology; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000378:metabolism* / Q000401:mortality; D010051:Ovarian Neoplasms / Q000378:metabolism* / Q000401:mortality; D010913:Pituitary-Adrenal System / Q000378:metabolism*; D011379:Prognosis; D016016:Proportional Hazards Models; D012463:Saliva / Q000737:chemistry
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D006854:Hydrocortisone
keywords: Biological markers; Chronobiology disorders; Hydrocortisone; Inflammation; Ovarian neoplasms
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