title: Epidemiologic factors that predict long-term survival following a diagnosis of epithelial ovarian cancer.
abstract: BACKGROUND
  Various epidemiologic factors have been shown to influence the risk of ovarian cancer development. Given the high fatality associated with this disease, it is of interest to evaluate the association of prediagnostic hormonal, reproductive, and lifestyle exposures with ovarian cancer-specific survival.
  
  
  METHODS
  We included 1421 patients with invasive epithelial ovarian cancer diagnosed in Ontario, Canada. Clinical information was obtained from medical records and prediagnostic exposure information was collected by telephone interview. Survival status was determined by linkage to the Ontario Cancer Registry. Proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for ovarian cancer-specific mortality associated with each exposure. Analyses were stratified by histologic subtype to further investigate the associations of risk factors on ovarian cancer-specific mortality.
  
  
  RESULTS
  After a mean follow-up of 9.48 years (range 0.59-20.32 years), 655 (46%) women had died of ovarian cancer. Parity (ever) was associated with a significant 29% decreased mortality risk compared with nulliparity (HR=0.71; 95% CI 0.54-0.93; P=0.01). There was a borderline significant association between ever use of oestrogen-containing hormone replacement therapy (HRT) and mortality (HR=0.79; 95% CI 0.62-1.01; P=0.06). A history of cigarette smoking was associated with a significant 25% increased risk of death compared with never smoking (HR=1.25; 95% CI 1.01-1.54; P=0.04). Women with a greater cumulative number of ovulatory cycles had a significantly decreased risk of ovarian cancer-specific death (HR=0.63; 95% CI 0.43-0.94; P=0.02). Increasing BMI (kg m-2) 5 years before diagnosis was associated with an increased risk of death (HR=1.17; 95% CI 1.07-1.28; P=0.0007). Other hormonal or lifestyle factors were not significantly associated with ovarian cancer-specific mortality.
  
  
  CONCLUSIONS
  Parity, ovulatory cycles, smoking, and BMI may affect survival following the diagnosis of ovarian cancer. Whether or not oestrogen-containing HRT use is beneficial for survival requires further evaluation.
authors.affiliation: Women's College Research Institute, Women's College Hospital, 76 Grenville, Toronto, ON, Canada.|Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
authors.forename: Shana J
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, Canada.|Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, 610 University Avenue, Toronto, ON, Canada.
authors.forename: Barry
authors.initials: B
authors.lastname: Rosen
authors.affiliation: Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, 600 University Avenue, Toronto, ON, Canada.
authors.forename: Isabel
authors.initials: I
authors.lastname: Fan
authors.affiliation: Women's College Research Institute, Women's College Hospital, 76 Grenville, Toronto, ON, Canada.|Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Science Building, Toronto, ON, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Ivanova
authors.affiliation: Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, 600 University Avenue, Toronto, ON, Canada.|Public Health Ontario, Toronto, ON, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: McLaughlin
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, USA.
authors.forename: Harvey
authors.initials: H
authors.lastname: Risch
authors.affiliation: Women's College Research Institute, Women's College Hospital, 76 Grenville, Toronto, ON, Canada.|Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Science Building, Toronto, ON, Canada.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Narod
authors.affiliation: Women's College Research Institute, Women's College Hospital, 76 Grenville, Toronto, ON, Canada.|Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.|Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Science Building, Toronto, ON, Canada.
authors.forename: Joanne
authors.initials: J
authors.lastname: Kotsopoulos
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D018284:Cystadenocarcinoma, Serous / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D015981:Epidemiologic Factors; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy / Q000401:mortality*; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D010298:Parity; D011247:Pregnancy; D011379:Prognosis; D017584:Reproductive History; D055815:Young Adult