title: Ovarian cancer survival by tumor dominance, a surrogate for site of origin.
abstract: OBJECTIVE
  Recent studies suggest that a proportion of ovarian tumors may actually originate in the distal fallopian tube. The objective of this study was to examine the relationship between dominance (a surrogate for site of origin) and survival, following a diagnosis of epithelial ovarian cancer.
  
  
  METHODS
  We classified 1,386 tumors as dominant (putatively originating in the ovary) and non-dominant (putatively originating in the fallopian tube), using parameters obtained from pathology reports. Dominant tumors were restricted to one ovary or one involved ovary that exceeded the other in dimension by at least twofold, while non-dominant tumors were identified as having a greater likelihood of a tubal origin if the disease was equally distributed across the ovaries. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) associated with dominance.
  
  
  RESULTS
  Non-dominant tumors were more likely to be serous, stage III/IV, and be associated with a BRCA1/2 mutation, increasing parity and use of estrogen hormone replacement therapy (p ≤ 0.01). In contrast, 46 and 26% of the dominant tumors were serous and endometrioid, respectively, with a more even distribution of stage (p < 0.0001). Women with a non-dominant tumor had an increased risk of death compared to women with a dominant tumor (multivariate HR 1.28; 95% CI 1.02-1.60). Findings were similar in our analysis restricted to serous only subtypes (HR 1.28; 95% CI 1.01-1.63).
  
  
  CONCLUSIONS
  These preliminary findings suggest significantly worse survival among women diagnosed with a tumor putatively arising from fallopian tube.
authors.affiliation: Women's College Research Institute, Women's College Hospital, 790 Bay Street, 7th Floor, Toronto, ON, M5G 1N8, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Ivanova
authors.forename: Anneli
authors.initials: A
authors.lastname: Loo
authors.forename: Shelley
authors.initials: S
authors.lastname: Tworoger
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Crum
authors.forename: Isabel
authors.initials: I
authors.lastname: Fan
authors.forename: John R
authors.initials: JR
authors.lastname: McLaughlin
authors.forename: Barry
authors.initials: B
authors.lastname: Rosen
authors.forename: Harvey
authors.initials: H
authors.lastname: Risch
authors.forename: Steven A
authors.initials: SA
authors.lastname: Narod
authors.forename: Joanne
authors.initials: J
authors.lastname: Kotsopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D005185:Fallopian Tube Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005187:Fallopian Tubes / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000453:epidemiology / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000473:pathology*; D055815:Young Adult