title: Metabolic Determinants and Anthropometric Indicators Impact Clinical-pathological Features in Epithelial Ovarian Cancer Patients.
abstract: BACKGROUND
  Over the last twenty years, the efforts of the scientific community devoted to the comprehension and treatment of ovarian cancer have remained poorly remunerative, with the case-fatality ratio of this disease remaining disappointedly high. Limited knowledge of the basic principles regulating ovarian carcinogenesis and factors impacting the course of disease may significantly impair our ability to intervene in early stages and lessen our expectations in terms of treatment outcomes. In the present study, we sought to assess whether metabolic factors and anthropometric indicators, i.e., pre-treatment fasting glucose and body mass index, are associated with renown cancer related prognostic factors such as tumour stage and grade at diagnosis.
  
  
  METHODS
  Study participants were 147 women diagnosed with epithelial ovarian cancer and treated with platinum based regimens and/or surgery at the Regina Elena National Cancer Institute of Rome, Italy. Glucose levels were assessed at the institutional laboratories on venous blood collected in overnight fasting conditions and prior to any therapeutic procedure. Stage was coded according to the FIGO staging system based on the results of the diagnostic workup, while tumour grade was locally assessed by an expert pathologist. Participants' characteristics were descriptively analyzed for the overall study population and in a subgroup of 70 patients for whom data on body mass index (BMI) were available. FIGO stage and grade were compared by categories of pre-treatment fasting glucose defined upon the median value, i.e., 89 mg/dl. The association of interest was tested in regression models including BMI.
  
  
  RESULTS
  For the overall study population, patients in the lowest category of fasting glucose were significantly more likely to exhibit a FIGO stage III-IV at diagnosis compared with their counterpart in the highest glucose category (81.3 vs 66.7%, p: 0.021). Subgroup analysis in 70 patients with BMI data confirmed this association (81.5 vs 55.8, p: 0.049), which remained significant when tested in regression models including BMI (OR: 0.28 95% CI 0.086-0.89, p: 0.031). No relevant evidence emerged when testing the association between fasting glucose and tumour grade.
  
  
  CONCLUSIONS
  In patients diagnosed with epithelial ovarian cancer, pre-treatment glucose levels appear to be inversely associated with FIGO stage. Further studies are warranted to eventually confirm and correctly interpret the implications of this novel finding.
authors.affiliation: 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Vici
authors.affiliation: 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pizzuti
authors.affiliation: 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Lauro
authors.affiliation: 2. Division of Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Conti
authors.affiliation: 2. Division of Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mandoj
authors.affiliation: 2. Division of Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Antenucci
authors.affiliation: 2. Division of Clinical Pathology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Digiesi
authors.affiliation: 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Sergi
authors.affiliation: 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Amodio
authors.affiliation: 3. Oncology Unit, Sant'Andrea Hospital, La Sapienza University of Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marchetti
authors.affiliation: 4. Biostatistics Unit-Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Sperati
authors.affiliation: 5. General Surgery, Regina Elena National Institute, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Valle
authors.affiliation: 5. General Surgery, Regina Elena National Institute, Rome, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Garofalo
authors.affiliation: 6. Gynecological Oncology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizza
authors.affiliation: 6. Gynecological Oncology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Corrado
authors.affiliation: 6. Gynecological Oncology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Vincenzoni
authors.affiliation: 7. Department of Gynecologic Oncology, University "Sapienza", Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Tomao
authors.affiliation: 8. Department of Radiology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Ramy
authors.initials: R
authors.lastname: Kayal
authors.affiliation: 8. Department of Radiology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Annalise
authors.initials: A
authors.lastname: Marsella
authors.affiliation: 9. Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Mariantonia
authors.initials: M
authors.lastname: Carosi
authors.affiliation: 9. Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Antoniani
authors.affiliation: 10. Sbarro Institute for Cancer Research and Molecular Medicine e del Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, USA; 11. Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Giordano
authors.affiliation: 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy; 12. Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Maugeri-Saccà
authors.affiliation: 1. Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy; 12. Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Barba
keywords: FIGO stage; body mass index; epithelial ovarian cancer; fasting glucose; tumour grade