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Smoking and Overweight: Negative Prognostic Factors in Stage III Epithelial Ovarian Cancer

¹ Institute of Cancer Epidemiology, Danish Cancer Society; ² Department of Pathology, Bispebjerg Hospital; ³ Department of Gynecology and Obstetrics, Copenhagen University Hospital, Copenhagen, Denmark; ⁴ Department of Gynecology and Obstetrics, Hillerød Hospital, Hillerød, Denmark; and ⁵ Department of Gynecology and Obstetrics, Skejby University Hospital, Aarhus, Denmark

Requests for reprints: Susanne K. Kjær, Danish Cancer Society, Institute of Cancer Epidemiology, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. Phone: 45-3525-7663; Fax: 45-3525-7731. E-mail: susanne{at}cancer.dk

Objective: Smoking and overweight are associated with poorer prognosis in several cancer types. The prognostic effect of smoking and body mass index (BMI) on ovarian cancer is unknown.

Methods: Ovarian cancer cases were from the Danish MALOVA (MALignant OVArian cancer) study. Information on smoking status and BMI was obtained from a personal interview conducted closely after primary surgery. Cox regression models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for ovarian cancer–specific death in relation to smoking variables and BMI.

Results: A total of 295 women with stage III epithelial ovarian cancer were identified and followed to death or for a median of 7.3 years (range, 5.4-9.5 years). Median survival time for normal-weight never smokers was 2.8 years (95% CI, 2.3-3.2) compared with 1.2 years (95% CI, 0.8-2.3) for overweight current smokers. Current smokers had a significantly increased risk of ovarian cancer death compared with never smokers in multivariate Cox analysis (HR, 1.65; 95% CI, 1.22-2.24). The negative effect of smoking diminished with increasing time since a former smoker had stopped smoking (HR, 0.89; 95% CI, 0.80-0.98 per 5 years since stop of smoking). Overweight women also had an increased risk of ovarian cancer death (HR, 1.83; 95% CI, 1.38-2.42) compared with normal-weight women.

Conclusion: Smoking at the time of diagnosis and premorbid overweight were negative prognostic factors for ovarian cancer–specific survival. The negative effect of smoking decreased with increasing time since stop of smoking. (Cancer Epidemiol Biomarkers Prev 2006;15(4):798–803)

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