Comorbidity and survival among women with ovarian cancer: evidence from prospective studies

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.... This is the first meta-analysis evaluating the association between comorbidity and survival following EOC diagnosis......

....First, a meta-analysis cannot control for confounders for which there was no adjustment in the primary analysis of individual studies. We excluded the study of Elit et al.²⁶ because they reported the crude risk estimates without adjustment for any potential confounders. In contrast, all included studies had been adjusted for at least two potential confounders in their primary analyses. Furthermore, we cannot exclude the possibility of unmeasured or residual confounding as a potential explanation for the observed associations. Several studies demonstrated that severe comorbidity was associated with older age, higher tumor stage, performance status, and cancer treatment^{7, 8}. Although we found that the associations were robust in analyses stratified by adjustment for these aforementioned confounding factors (Table 2), less than half the studies adjusted for tumor grade and histology and only two studies adjusted for cancer treatment or residual tumor. Therefore, further studies stratified by established or additional prognostic factors are warranted to better rule out potential effects of residual confounding.....

 In conclusion, the results from this meta-analysis, based on prospective studies, suggest that comorbidity has a negative impact on EOC survival. The status and severity of comorbid diseases should be taken into consideration by clinicians when making decisions on EOC management. Further studies need to figure out which individual comorbid diseases may have the greatest impact on survival of EOC patients.