title: Nonsteroidal Anti-inflammatory Drugs and Endometrial Carcinoma Mortality and Recurrence.
abstract: Recent data suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with reductions in endometrial cancer risk, yet very few have examined whether their use is related to prognosis among endometrial cancer patients.
  
  
  
  Study subjects comprised 4374 participants of the NRG Oncology/Gynecology Oncology Group 210 Study with endometrial carcinoma who completed a presurgical questionnaire that assessed history of regular prediagnostic NSAID use and endometrial cancer risk factors. Recurrences, vital status, and causes of death were obtained from medical records and cancer registries. Fine-Gray semiproportional hazards regression estimated adjusted subhazard ratios (HRs) and 95% confidence intervals (CIs) for associations of NSAID use with endometrial carcinoma-specific mortality and recurrence. Models were stratified by endometrial carcinoma type (ie, type I [endometrioid] vs type II [serous, clear cell, or carcinosarcoma]) and histology.
  
  
  
  Five hundred fifty endometrial carcinoma-specific deaths and 737 recurrences occurred during a median of five years of follow-up. NSAID use was associated with 66% (HR = 1.66, 95% CI = 1.21 to 2.30) increased endometrial carcinoma-specific mortality among women with type I cancers. Associations were statistically significant for former and current users, and strongest among former users who used NSAIDs for 10 years or longer (HR = 2.23, 95% CI = 1.19 to 4.18, two-sided P trend = .01). NSAID use was not associated with recurrence or endometrial carcinoma-specific mortality among women with type II tumors.
  
  
  
  In this study, use of NSAIDs was associated with increased endometrial carcinoma-specific mortality, especially in patients with type I tumors. Barring a clear biologic mechanism by which NSAIDs would increase the risk of cause-specific mortality, cautious interpretation is warranted.
authors.affiliation: Division of Cancer Prevention and Control, Ohio State University, Columbus, OH, USA.
authors.forename: Theodore M
authors.initials: TM
authors.lastname: Brasky
authors.affiliation: College of Medicine, and Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA.|Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.|Cancer Prevention Fellowship Program, Division of Cancer Prevention,  National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Felix
authors.affiliation: Division of Gynecologic Oncology, Ohio State University, Columbus, OH, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
authors.affiliation: Stephenson Oklahoma Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Oklahoma, USA.
authors.forename: D Scott
authors.initials: DS
authors.lastname: McMeekin
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Mutch
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Creasman
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Premal H
authors.initials: PH
authors.lastname: Thaker
authors.affiliation: Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Walker
authors.affiliation: Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital/Brown University, Providence, RI, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Moore
authors.affiliation: Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Shashikant B
authors.initials: SB
authors.lastname: Lele
authors.affiliation: Gynecologic Oncology, University of Colorado Cancer Center, Aurora, CO, USA.
authors.forename: Saketh R
authors.initials: SR
authors.lastname: Guntupalli
authors.affiliation: Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Levi S
authors.initials: LS
authors.lastname: Downs
authors.affiliation: Division of Gynecologic Oncology, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Christa I
authors.initials: CI
authors.lastname: Nagel
authors.affiliation: Gynecologic Oncology Program, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Boggess
authors.affiliation: Gynecologic Oncology, State University of New York at Stonybrook, Stonybrook, NY , USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Pearl
authors.affiliation: Anatomical Pathology, University of Maryland, College Park, MD, USA.
authors.forename: Olga B
authors.initials: OB
authors.lastname: Ioffe
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Kay J
authors.initials: KJ
authors.lastname: Park
authors.affiliation: NRG Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Shamshad
authors.initials: S
authors.lastname: Ali
authors.affiliation: Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Brinton
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality* / Q000473:pathology; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018269:Carcinoma, Endometrioid / Q000401:mortality* / Q000473:pathology; D002296:Carcinosarcoma / Q000401:mortality* / Q000473:pathology; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal