abstract
OBJECTIVES:
Prognostic risk factors influencing survival in patients with epithelial ovarian cancer
(EOC) include tumor stage, grade, histologic subtype, debulking, and
platinum status. Little is known about the impact of hormonal milieu and
reproductive factors before cancer
diagnosis on clinical outcome. We sought to evaluate whether oral
contraceptive (OC) use carries any prognostic significance on overall survival (OS) in patients with EOC.
METHODS:
Newly
diagnosed patients with EOC, fallopian tube, and primary peritoneal
cancers between 1982 and 1998 were prospectively evaluated with a
comprehensive epidemiologic questionnaire. A retrospective chart review
was performed to abstract clinicopathologic data, including OS. A
Kaplan-Meier analysis was performed to compare survival
across various exposures. A Cox regression model was used to compute
adjusted hazards ratios (aHRs) and 95% confidence intervals (CIs).
RESULTS:
We
identified 387 newly diagnosed cancers with evaluable information in
this cohort. Decreased risk of death was observed in women who reported
prior use of OC, previous pregnancy, or a live birth after adjusting for age at diagnosis, stage, and histologic
subtype. Oral contraceptive use was associated with a crude reduced risk
of death, with reported median OS of 81
months in OC users versus 46 months in nonusers. Patients who reported a
single live birth experienced the largest potential survival advantage. Oral contraceptive use and prior pregnancy were associated with improved survival across all strata.
CONCLUSIONS:
Oral contraceptive use may have lasting effects on epithelial ovarian
tumor characteristics conferring favorable prognosis. Putative
mechanisms that affect tumor biology include complex interactions
between ovarian
cells, host immune cells, and hormonal microenvironment during
carcinogenesis. Future efforts should be directed to determine the role
of reproductive factors in antitumor immunity.
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