History of hypertension, heart disease, and diabetes and ovarian cancer patient survival: evidence from the ovarian cancer association consortium

Albina N Minlikeeva, Jo L Freudenheim, Rikki A Cannioto, J Brian Szender, Kevin H Eng, Francesmary Modugno, Roberta B Ness, Michael J LaMonte, Grace Friel, Brahm H Segal, Kunle Odunsi, Paul Mayor, Emese Zsiros, Barbara Schmalfeldt, Rüdiger Klapdor, Thilo Dӧrk, Peter Hillemanns, Linda E Kelemen, Martin Kӧbel, Helen SteedAnna de Fazio, Susan J Jordan, Christina M Nagle, Harvey A Risch, Mary Anne Rossing, Jennifer A Doherty, Marc T Goodman, Robert Edwards, Keitaro Matsuo, Mika Mizuno, Beth Y Karlan, Susanne K Kjær, Estrid Høgdall, Allan Jensen, Joellen M Schildkraut, Kathryn L Terry, Daniel W Cramer, Elisa V Bandera, Lisa E Paddock, Lambertus A Kiemeney, Leon F Massuger, Jolanta Kupryjanczyk, Andrew Berchuck, Jenny Chang-Claude, Brenda Diergaarde, Penelope M Webb, Kirsten B Moysich, Australian Ovarian Cancer Study Group

17 Citations (Scopus)

Abstract

PURPOSE: Survival following ovarian cancer diagnosis is generally low; understanding factors related to prognosis could be important to optimize treatment. The role of previously diagnosed comorbidities and use of medications for those conditions in relation to prognosis for ovarian cancer patients has not been studied extensively, particularly according to histological subtype.

METHODS: Using pooled data from fifteen studies participating in the Ovarian Cancer Association Consortium, we examined the associations between history of hypertension, heart disease, diabetes, and medications taken for these conditions and overall survival (OS) and progression-free survival (PFS) among patients diagnosed with invasive epithelial ovarian carcinoma. We used Cox proportional hazards regression models adjusted for age and stage to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) overall and within strata of histological subtypes.

RESULTS: History of diabetes was associated with increased risk of mortality (n = 7,674; HR = 1.12; 95% CI = 1.01-1.25). No significant mortality associations were observed for hypertension (n = 6,482; HR = 0.95; 95% CI = 0.88-1.02) or heart disease (n = 4,252; HR = 1.05; 95% CI = 0.87-1.27). No association of these comorbidities was found with PFS in the overall study population. However, among patients with endometrioid tumors, hypertension was associated with lower risk of progression (n = 339, HR = 0.54; 95% CI = 0.35-0.84). Comorbidity was not associated with OS or PFS for any of the other histological subtypes. Ever use of beta blockers, oral antidiabetic medications, and insulin was associated with increased mortality, HR = 1.20; 95% CI = 1.03-1.40, HR = 1.28; 95% CI = 1.05-1.55, and HR = 1.63; 95% CI = 1.20-2.20, respectively. Ever use of diuretics was inversely associated with mortality, HR = 0.71; 95% CI = 0.53-0.94.

CONCLUSIONS: Histories of hypertension, diabetes, and use of diuretics, beta blockers, insulin, and oral antidiabetic medications may influence the survival of ovarian cancer patients. Understanding mechanisms for these observations could provide insight regarding treatment.

Original languageEnglish
JournalCancer Causes & Control
Volume28
Issue number5
Pages (from-to)469-486
ISSN0957-5243
DOIs
Publication statusPublished - 1 May 2017

Keywords

  • Adrenergic beta-Antagonists/therapeutic use
  • Adult
  • Aged
  • Diabetes Mellitus/drug therapy
  • Disease-Free Survival
  • Female
  • Heart Diseases/complications
  • Humans
  • Hypertension/complications
  • Hypoglycemic Agents/therapeutic use
  • Insulin/therapeutic use
  • Middle Aged
  • Ovarian Neoplasms/complications
  • Risk
  • Survival Rate

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