title: The effect of metabolic comorbidities and commonly used drugs on the prognosis of patients with ovarian cancer.
abstract: BACKGROUND
  Diabetes mellitus is associated with an increased risk of recurrence in patients with ovarian cancer. Retrospective studies suggested that the use of statins, metformin and beta blockers is associated with improved prognosis in these patients. Patients with diabetes often suffer from hypertension and are usually treated concomitantly by several classes of drugs. Our aim was to assess the independent contribution of diabetes mellitus and hypertension and of the use of aspirin, statins, metformin and beta blockers on the risk of ovarian cancer recurrence and mortality.
  
  
  METHODS
  Files of ovarian cancer patients treated between 2000 and 2012 were retrospectively reviewed. Data regarding disease characteristics, presence of diabetes mellitus and hypertension, recurrence and death were extracted. The use of drugs was assessed using the Clalit Health Services (CHS) pharmacy records.
  
  
  RESULTS
  143 patients treated by debulking surgery and platinum based chemotherapy were included. Median age was 62.5, 22 (15.4%) had diabetes mellitus, 61 (42.7%) had chronic hypertension. Statins were used by 43 (30%) patients, 31 (21.7%) used aspirin, 25 (17.5%) used beta blockers and 12 (8.4%) used metformin. In multivariate analysis diabetes mellitus was associated with a shorter recurrence free survival (RFS) and the use of aspirin and metformin was associated with a prolonged RFS in this cohort. Overall survival (OS) was longer in patients using aspirin and shorter in patients with hypertension.
  
  
  CONCLUSIONS
  Our data suggests that metabolic comorbidities and commonly used drugs are associated with the prognosis of patients with ovarian cancer. Additional trials are needed to confirm these observations and test therapeutic interventions.
authors.affiliation: Gynecology-Oncology Unit, Department of Obstetrics and Gynecology, Carmel Lady Davis Medical Center, Haifa, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bar
authors.affiliation: Gynecology-Oncology Unit, Department of Obstetrics and Gynecology, Carmel Lady Davis Medical Center, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion-Israeli Institute of Technology, Haifa, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Lavie
authors.affiliation: Department of Community Medicine and Epidemiology, Carmel Lady Davis Medical Center, Haifa, Israel.
authors.forename: Nili
authors.initials: N
authors.lastname: Stein
authors.affiliation: Gynecology-Oncology Unit, Department of Obstetrics and Gynecology, Carmel Lady Davis Medical Center, Haifa, Israel.
authors.forename: Ido
authors.initials: I
authors.lastname: Feferkorn
authors.affiliation: Department of Oncology, Galilee Medical Center, Nahariyya, Israel; Faculty of Medicine, Bar Illan University, Zafed, Israel. Electronic address: ayelets@gmc.gov.il.
authors.forename: Ayelet
authors.initials: A
authors.lastname: Shai
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002173:Cancer Care Facilities; D015331:Cohort Studies; D003131:Combined Modality Therapy; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007557:Israel / Q000453:epidemiology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000139:chemically induced / Q000517:prevention & control*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D010053:Ovary / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents
keywords: Aspirin; Diabetes; Hypertension; Metabolic syndrome; Ovarian cancer; Statins