title: Cigarette smoking is associated with adverse survival among women with ovarian cancer: Results from a pooled analysis of 19 studies.
abstract: Cigarette smoking is associated with an increased risk of developing mucinous ovarian tumors but whether it is associated with ovarian cancer survival overall or for the different histotypes is unestablished. Furthermore, it is unknown whether the association between cigarette smoking and survival differs according to strata of ovarian cancer stage at diagnosis. In a large pooled analysis, we evaluated the association between various measures of cigarette smoking and survival among women with epithelial ovarian cancer. We obtained data from 19 case-control studies in the Ovarian Cancer Association Consortium (OCAC), including 9,114 women diagnosed with ovarian cancer. Cox regression models were used to estimate adjusted study-specific hazard ratios (HRs), which were combined into pooled hazard ratios (pHR) with corresponding 95% confidence intervals (CIs) under random effects models. Overall, 5,149 (57%) women died during a median follow-up period of 7.0 years. Among women diagnosed with ovarian cancer, both current (pHR = 1.17, 95% CI: 1.08-1.28) and former smokers (pHR = 1.10, 95% CI: 1.02-1.18) had worse survival compared with never smoking women. In histotype-stratified analyses, associations were observed for mucinous (current smoking: pHR = 1.91, 95% CI: 1.01-3.65) and serous histotypes (current smoking: pHR = 1.11, 95% CI: 1.00-1.23; former smoking: pHR = 1.12, 95% CI: 1.04-1.20). Further, our results suggested that current smoking has a greater impact on survival among women with localized than disseminated disease. The identification of cigarette smoking as a modifiable factor associated with survival has potential clinical importance as a focus area to improve ovarian cancer prognosis.
authors.affiliation: Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Camilla
authors.initials: C
authors.lastname: Praestegaard
authors.affiliation: Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Allan
authors.initials: A
authors.lastname: Jensen
authors.affiliation: Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Signe M
authors.initials: SM
authors.lastname: Jensen
authors.affiliation: Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Thor S S
authors.initials: TS
authors.lastname: Nielsen
authors.affiliation: Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.
authors.forename: Penelope M
authors.initials: PM
authors.lastname: Webb
authors.affiliation: Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Nagle
authors.affiliation: Centre for Cancer Research, The Westmead Millenium Institute for Medical Research, The University of Sydney Westmead, NSW, Australia.|Department of Gynecological Oncology, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: DeFazio
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
authors.affiliation: Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.|Molecular Unit, Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Estrid
authors.initials: E
authors.lastname: Høgdall
authors.affiliation: Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.|Department of Epidemiology, University of Washington, Seattle, WA.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Rossing
authors.affiliation: Department of Epidemiology, The Geisel School of Medicine, Dartmouth College, Hanover, NH.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Doherty
authors.affiliation: Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Kristine G
authors.initials: KG
authors.lastname: Wicklund
authors.affiliation: Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.|Community and Population Health Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Marc T
authors.initials: MT
authors.lastname: Goodman
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA.|Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.|Ovarian Cancer Center of Excellence, Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, PA.
authors.forename: Francesmary
authors.initials: F
authors.lastname: Modugno
authors.affiliation: Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Moysich
authors.affiliation: School of Public Health, The University of Texas, Houston, TX.
authors.forename: Roberta B
authors.initials: RB
authors.lastname: Ness
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA.|Ovarian Cancer Center of Excellence, Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, PA.
authors.forename: Robert
authors.initials: R
authors.lastname: Edwards
authors.affiliation: Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Division of Epidemiology and Prevention, Aichi Cancer Center Research institute, Nagoya, Aichi, Japan.
authors.forename: Satoyo
authors.initials: S
authors.lastname: Hosono
authors.affiliation: Department of Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, MN.
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Goode
authors.affiliation: Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Stacey J
authors.initials: SJ
authors.lastname: Winham
authors.affiliation: University of Kansas Medical Center, Kansas City, KS.
authors.forename: Brooke L
authors.initials: BL
authors.lastname: Fridley
authors.affiliation: Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA.|Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Cramer
authors.affiliation: Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, MA.|Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Terry
authors.affiliation: Department of Public Health Science, School of Medicine, University of Virginia, Charlottesville, VA.
authors.forename: Joellen M
authors.initials: JM
authors.lastname: Schildkraut
authors.affiliation: Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.
authors.forename: Andrew
authors.initials: A
authors.lastname: Berchuck
authors.affiliation: Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.|Rutgers School of Public Health, Piscataway, NJ.
authors.forename: Elisa V
authors.initials: EV
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authors.affiliation: New Jersey Department of Health and Senior Services, Trenton, NJ.|School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Paddock
authors.affiliation: Department of Gynaecology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.
authors.forename: Leon F
authors.initials: LF
authors.lastname: Massuger
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Wentzensen
authors.affiliation: Department of Oncology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research laboratory, Cambridge, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Pharoah
authors.affiliation: Department of Oncology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research laboratory, Cambridge, United Kingdom.
authors.forename: Honglin
authors.initials: H
authors.lastname: Song
authors.affiliation: Department of Health Research and Policy - Epidemiology, Stanford University School of Medicine, Stanford, CA.|Departments of Health Research & Policy and of Biomedical Data Science, Stanford School of Medicine, Stanford, CA.
authors.forename: Alice
authors.initials: A
authors.lastname: Whittemore
authors.affiliation: Department of Health Research and Policy - Epidemiology, Stanford University School of Medicine, Stanford, CA.
authors.forename: Valerie
authors.initials: V
authors.lastname: McGuire
authors.affiliation: Departments of Population Health Science & Policy and of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Weiva
authors.initials: W
authors.lastname: Sieh
authors.affiliation: Departments of Population Health Science & Policy and of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rothstein
authors.affiliation: Department of Epidemiology, Center for Cancer Genetics Research & Prevention, School of Medicine, University of California Irvine, Irvine, CA.
authors.forename: Hoda
authors.initials: H
authors.lastname: Anton-Culver
authors.affiliation: Department of Epidemiology, University of California Irvine, Irvine, CA.
authors.forename: Argyrios
authors.initials: A
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authors.affiliation: Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom.
authors.forename: Usha
authors.initials: U
authors.lastname: Menon
authors.affiliation: Center for Cancer Prevention and Translational Genomics, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.|Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Simon A
authors.initials: SA
authors.lastname: Gayther
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.|The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Ramus
authors.affiliation: Women's Cancer, Institute for Women's Health, University College London, London, United Kingdom.
authors.forename: Alexandra
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authors.lastname: Gentry-Maharaj
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA.
authors.forename: Anna H
authors.initials: AH
authors.lastname: Wu
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA.|Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
authors.forename: Celeste L
authors.initials: CL
authors.lastname: Pearce
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA.|Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Pike
authors.affiliation: Department of Health Science, California State University, Fullerton, CA.
authors.forename: Alice W
authors.initials: AW
authors.lastname: Lee
authors.affiliation: Epidemiology Center, College of Medicine, University of South Florida, Tampa, FL.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sutphen
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.|University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang-Claude
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
authors.forename: Harvey A
authors.initials: HA
authors.lastname: Risch
authors.affiliation: Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.|Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Susanne K
authors.initials: SK
authors.lastname: Kjaer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality*; D010051:Ovarian Neoplasms / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D014026:Nicotiana / Q000009:adverse effects*; D055815:Young Adult
keywords: cigarette smoking; ovarian cancer; pooled analysis; survival