title: Smoking may modify the association between neoadjuvant chemotherapy and survival from ovarian cancer.
abstract: OBJECTIVE
  Tobacco smoking by cancer patients is associated with increased mortality. Less is known of the impact of smoking on recurrence risk and interaction with chemotherapy treatment. We examined these associations in ovarian cancer.
  
  
  METHODS
  Patients were identified from the Alberta Cancer Registry between 1978 and 2010 and were oversampled for less-common histologic ovarian tumor types. Medical records were abstracted for 678 eligible patients on lifestyle, medical and cancer treatment, and review of pathology slides was performed for 605 patients. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using Cox proportional hazard models adjusted for age at diagnosis, race, stage and residual disease.
  
  
  RESULTS
  Among patients receiving adjuvant chemotherapy (N=432), current smoking was significantly associated with shorter duration of overall (OS; HR, 8.56; 95% CI, 1.50-48.7) and progression-free (PFS; HR, 5.74; 95% CI, 1.05-31.4) survival from mucinous ovarian cancer only. There was no significant association between neoadjuvant chemotherapy and survival. However, among patients receiving neoadjuvant chemotherapy (N=44), current smokers had shorter PFS (HR, 4.32; 95% CI, 1.36-13.8; N=32 progressed/9 censored events) compared to never smokers, but the HRs were not statistically different across smoking categories (P interaction=0.87).
  
  
  CONCLUSIONS
  Adverse associations were observed between smoking status and OS or PFS among patients with mucinous ovarian cancer receiving adjuvant chemotherapy. No significant effect was found from neoadjuvant chemotherapy on PFS overall; however, smoking may modify this association. Although needing replication, these findings suggest that patients may benefit from smoking cessation interventions prior to treatment with chemotherapy.
authors.affiliation: Alberta Health Services-Cancer Control Alberta, 2210 2nd Street SW, Calgary, AB T2S 3C3, Canada. Electronic address: kelemen@musc.edu.
authors.forename: Linda E
authors.initials: LE
authors.lastname: Kelemen
authors.affiliation: Department of Radiation Oncology, Medical University of South Carolina, 169 Ashley Avenue, Charleston, SC 29425, USA; Department of Cell and Molecular Pharmacology, Medical University of South Carolina, 169 Ashley Avenue, Charleston, SC 29425, USA; Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC 29425, USA. Electronic address: warrengw@musc.edu.
authors.forename: Graham W
authors.initials: GW
authors.lastname: Warren
authors.affiliation: Alberta Health Services-Cancer Control Alberta, 2210 2nd Street SW, Calgary, AB T2S 3C3, Canada. Electronic address: jen.koziak@gmail.com.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Koziak
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada. Electronic address: martin.koebel@cls.ab.ca.
authors.forename: Martin
authors.initials: M
authors.lastname: Köbel
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, S5-131 Lois Hole Hospital, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton, AB T5H 3V9, Canada. Electronic address: helen.steed@albertahealthservices.ca.
authors.forename: Helen
authors.initials: H
authors.lastname: Steed
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D020360:Neoadjuvant Therapy; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D016016:Proportional Hazards Models; D012907:Smoking / Q000453:epidemiology*
keywords: Chemotherapy; Mucinous carcinoma; Ovarian neoplasms; Tobacco