title: Diabetes mellitus and long-term mortality of ovarian cancer patients. A systematic review and meta-analysis of 12 cohort studies.
abstract: Ovarian cancer (OC) is the sixth most common cancer among women, and its prognosis is not favorable. Diabetes mellitus (DM) is hypothesized to be associated with a higher mortality in ovarian cancer patients, but evidence is inconsistent. Thus, we aim to investigate if DM is associated with the long-term all-cause and long-term cancer-specific mortality in ovarian cancer patients by synthesizing available epidemiologic evidences. We used 4 electronic databases (PubMed, EMBASE, Web of Science, and Scopus) to search for eligible articles. Title/abstract screening, full-text review, data extraction, and quality assessment were performed by reviewers independently. In meta-analysis, studies reporting risk ratio (RR) or hazard ratio that investigated the association between DM and mortality of OC patients were synthesized by a random-effect model. Subgroup and sensitivity analyses were performed by certain stratification or restrictive rules. Publication bias was assessed by funnel plots and Egger test. Statistical heterogeneity was evaluated by the I-squared value and a chi-squared test for the Cochrane Q statistic. Twelve cohort studies involving 14 outcome measures were included. In overall meta-analysis, the synthesized RR for all-cause mortality was 1.44 (95% CI 1.16-1.79) without substantial statistical heterogeneity (PCochrane= .145, I2= 34.1%); the synthesized RR for cancer-specific mortality was 1.44 (95% CI 1.08-1.93) with substantial heterogeneity (PCochrane< .001, I2= 90.1%). No publication bias was observed. Our results suggest DM is associated with a higher all-cause and cancer-specific mortality in ovarian cancer patients. Future studies should be done to examine the association between type 1 DM and ovarian cancer mortality.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Dongyu
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Tengteng
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Yuzhi
authors.initials: Y
authors.lastname: Xi
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Nan
authors.initials: N
authors.lastname: Li
authors.affiliation: Department of Environmental Health and Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA.
authors.forename: Hongtai
authors.initials: H
authors.lastname: Huang
mesh_terms: D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000401:mortality*; D015996:Survival Rate
keywords: diabetes mellitus; mortality; ovarian cancer; systematic review and meta-analysis