Tumor- and treatment-related factors are established predictors of ovarian cancer survival. New studies suggest a differential impact of exposures on ovarian cancer survival trajectories (i.e., rapidly fatal to long-term disease). This study examined the impact of pre-diagnostic risk factors on short- and long-term ovarian cancer survival trajectories in the Canadian context. This population-based longitudinal observational study included women diagnosed with invasive epithelial ovarian cancer from 1995 to 2004 in Ontario. Data were obtained from medical records, interviews, and the provincial cancer registry. Extended Cox proportional hazard models estimated the association between risk factors and all-cause and ovarian cancer-specific mortality by survival time intervals (<3 years (i.e., short-term survival), 3 to <6 years, 6 to <10 years, and ≥10 years (i.e., long-term survival)). Among 1421 women, histology, stage, and residual disease were the most important predictors of all-cause mortality in all survival trajectories, particularly for short-term survival. Reproductive and lifestyle factors did not strongly impact short-term overall survival but were associated with long-term overall survival. As such, among long-term survivors, history of breastfeeding significantly decreased the risk of all-cause mortality (HR 0.65; 95% CI 0.46, 0.93;p< 0.05), whereas smoking history (HR 1.75; 95% CI 1.27, 2.40;p< 0.05) and obesity (HR 1.81; 95% CI 1.24, 2.65;p< 0.05) significantly increased the risk of all-cause mortality. The findings were consistent with ovarian cancer-specific mortality. These findings suggest that pre-diagnostic exposures differentially influence survival time following a diagnosis of ovarian cancer.
肿瘤相关因素与治疗相关因素已被确认为卵巢癌生存期的预测指标。最新研究表明，不同暴露因素对卵巢癌生存轨迹（即从快速致命到长期带病生存）的影响存在差异。本研究在加拿大背景下探讨了诊断前危险因素对卵巢癌短期与长期生存轨迹的影响。这项基于人群的纵向观察性研究纳入了1995年至2004年间在安大略省确诊为侵袭性上皮性卵巢癌的女性患者。数据来源于医疗记录、访谈记录及省级癌症登记系统。通过扩展Cox比例风险模型，评估了危险因素与全因死亡率及卵巢癌特异性死亡率在不同生存时间段（＜3年（即短期生存）、3至＜6年、6至＜10年及≥10年（即长期生存））的关联性。在1421例患者中，组织学类型、分期及残留病灶是所有生存轨迹中全因死亡率最重要的预测因素，尤其对短期生存影响显著。生殖因素与生活方式因素对短期总生存率影响较弱，但与长期总生存率显著相关。具体而言，在长期生存者中，母乳喂养史可显著降低全因死亡风险（HR 0.65；95% CI 0.46, 0.93；p<0.05），而吸烟史（HR 1.75；95% CI 1.27, 2.40；p<0.05）与肥胖（HR 1.81；95% CI 1.24, 2.65；p<0.05）则显著增加全因死亡风险。该结果与卵巢癌特异性死亡率分析结论一致。这些发现表明，诊断前暴露因素对卵巢癌确诊后的生存时间具有差异化影响。
肿瘤(癌症)患者之家