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Oral contraceptive use and reproductive characteristics affect survival in patients with epithelial ovarian cancer
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Abstracts / Gynecologic Oncology 137 (2015) 92–179
were used to dichotomize stores as HQS, and the kernel density of HQS per census tract was estimated in ArcGIS. Chi square statistics were used to test the difference in HQS density for covariates. Multivariate Cox proportional hazards models were used to estimate the association between 5-year survival and HQS density, adjusting for clinical and demographic factors. Results: Fewer NHB patients lived in census tracts with high HQS density (NHB: 94 of 836, 11%; NHW: 721 of 3,628, 20%; P b 0.0001). Census tracts with high HQS density also had the highest concentrated affluence and lowest concentrated disadvantage (P b 0.0001 for both). HQS density was significantly associated with improved 5year survival in crude models (HR = 0.80, 95% CI 0.70–0.91), which persisted after adjusting for age, race, clinical factors, and neighborhood-level concentrated disadvantage and affluence (HR = 0.83, 95% CI 0.73–0.95). Conclusions: Results indicate that HQS density is significantly associated with improved 5-year survival among women diagnosed with ovarian cancer in Cook County, IL. Access to fresh fruits and vegetables may contribute to ovarian cancer survival disparities and may have implications for chronic disease as well. doi:10.1016/j.ygyno.2015.01.257
255 — Poster Session The effect of time on racial differences in ovarian cancer stage at diagnosis among cases identified through the National Cancer Database A. Beckmeyer-Borowkoa, K.C. Brewera, C.E. Petersona,b, M.A. Otooa,c, F. Davisd, K. Hoskinsc, C.E. Joslina,b,c. aUniversity of Illinois at Chicago School of Public Health, Chicago, IL, USA, bUniversity of Illinois at Chicago Cancer Center, Chicago, IL, USA, cUniversity of Illinois College of Medicine, Chicago, IL, USA, dUniversity of Alberta School of Public Health, Edmonton, AB, Canada Objectives: Past research is inconclusive regarding racial differences in stage at diagnosis between non-Hispanic black (NHB) and nonHispanic white (NHW) women with epithelial ovarian cancer. The purpose of this analysis was to determine whether racial differences in stage at diagnosis were present in women diagnosed with ovarian cancer in the United States and Puerto Rico between 1998 and 2011 and to assess whether differences changed over time. Methods: NHW and NHB cases reported in the National Cancer Database (NCDB) were analyzed to evaluate differences in stage at diagnosis. Stage was dichotomized as early (stages I and II) vs. late (stages III and IV), and year of diagnosis was analyzed in three periods (1998–2002, 2003–2007, 2008–2011). Chi square was used to test differences between demographic and clinical factors (age, income, education, insurance status, facility location, tumor grade, period of diagnosis) and stage at diagnosis. Multivariable logistic regression was used to estimate the adjusted odds ratio (OR) and 95% CI for the association between race and late stage at diagnosis. Interaction between race and year of diagnosis was tested in the final model. Results: A total of 142,088 (92.2%) NHW and 12,086 (7.8%) NHB women were analyzed. NHB women had a significantly higher odds of late-stage diagnosis than NHW women (ORadj = 1.34, 95%CI 1.27–1.41). Interaction between race and period of diagnosis was statistically significant (P = 0.04), with disparities decreasing over time (OR and 95% CI, 1998–2002: 1.49, 1.36–1.63; 2003–2007: 1.33, 1.22–1.45; 2008–2011: 1.21, 1.11–1.32). Conclusions: Results indicate that within NCDB, NHB women are more likely to be diagnosed with late-stage ovarian cancer, yet these differences are decreasing with time. These findings of improved black-white differences in stage at diagnosis could be due, in part, to
improved access to care. Results may be underestimated because NCDB reflects approximately 70% of United States cases annually, generally including higher-tier, Commission on Cancer (CoC)approved hospitals, whose members may have changed over time. doi:10.1016/j.ygyno.2015.01.258
256 — Poster Session Oral contraceptive use and reproductive characteristics affect survival in patients with epithelial ovarian cancer N.V. Kolomeyevskaya, G. Zirpoli, M. Ruszczyk, K.S. Grzankowski, S.B. Lele, K.O. Odunsi, K. Moysich. Roswell Park Cancer Institute, Buffalo, NY, USA Objectives: Prognostic risk factors influencing survival in patients with epithelial ovarian cancer (EOC) include tumor stage, grade, histologic subtype, debulking status, and platinum sensitivity. Little is known about the impact of the hormonal milieu and reproductive factors before cancer diagnosis on clinical outcome. We sought to evaluate whether oral contraceptive (OC) use, gravidity, and parity have any prognostic significance on overall survival (OS) in patients with EOC. Methods: We included 387 patients with EOC, fallopian, and primary peritoneal cancers treated from 1982 to 1998 who completed a comprehensive epidemiologic questionnaire. Retrospective chart review was performed to abstract clinicopathologic data. OS was determined; Kaplan–Meier analysis was performed to compare survival across categorical exposures with differences tested using the log-rank test, while continuous variables were analyzed with Cox regression. Cox regression model was used to compute adjusted hazard ratios (aHRs) and 95% CIs. Results: After adjusting for age at diagnosis, stage, and histologic subtype, decreased risk of death was observed in women who reported prior use of OC (aHR 0.79, 95% CI 0.58–1.09), previous pregnancy (aHR 0.77, 95% CI 0.57–1.04), or a live birth (aHR 0.81, 95% CI 0.60–1.08). OC use was associated with a crude reduced risk of death (HR 0.55, 95% CI 0.42–0.72), with reported median OS of 81 months in OC users compared with 46 months in nonusers. Patients who reported a single live birth experienced the largest potential survival advantage (aHR 0.61, 95% CI 0.39–0.94). OC use and prior pregnancy were associated with improved survival across all histologic subtypes, stages, and grades. Conclusions: Our findings suggest that OC use, gravidity, and parity may have long-lasting effects on epithelial ovarian tumor characteristics conferring favorable prognosis. Putative mechanisms may stem from complex interactions between ovarian cells, host immune cells, and hormonal microenvironment during carcinogenesis that ultimately affect tumor biology. Future efforts should be directed at determining the role of host reproductive factors in antitumor immunity. doi:10.1016/j.ygyno.2015.01.259
257 — Poster Session Diagnostic value of combined 18F-FDG positron emission tomography/computed tomography in recurrent epithelial ovarian cancer with non-disseminated lesions: Correlation with pathologic diagnosis of the secondary cytoreduction P.S. Jung, S.W. Lee, J.Y. Park, D.S. Suh, D.Y. Kim, J.H. Kim, Y.M. Kim, Y.T. Kim, J.H. Nam. University of Ulsan College of Medicine, ASAN Medical Center, Seoul, South Korea Objectives: To evaluate the diagnostic accuracy of combined 18Ffluoro-2-deoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) imaging in suspected recurrence of
Abstracts / Gynecologic Oncology 137 (2015) 92–179
were used to dichotomize stores as HQS, and the kernel density of HQS per census tract was estimated in ArcGIS. Chi square statistics were used to test the difference in HQS density for covariates. Multivariate Cox proportional hazards models were used to estimate the association between 5-year survival and HQS density, adjusting for clinical and demographic factors. Results: Fewer NHB patients lived in census tracts with high HQS density (NHB: 94 of 836, 11%; NHW: 721 of 3,628, 20%; P b 0.0001). Census tracts with high HQS density also had the highest concentrated affluence and lowest concentrated disadvantage (P b 0.0001 for both). HQS density was significantly associated with improved 5year survival in crude models (HR = 0.80, 95% CI 0.70–0.91), which persisted after adjusting for age, race, clinical factors, and neighborhood-level concentrated disadvantage and affluence (HR = 0.83, 95% CI 0.73–0.95). Conclusions: Results indicate that HQS density is significantly associated with improved 5-year survival among women diagnosed with ovarian cancer in Cook County, IL. Access to fresh fruits and vegetables may contribute to ovarian cancer survival disparities and may have implications for chronic disease as well. doi:10.1016/j.ygyno.2015.01.257
255 — Poster Session The effect of time on racial differences in ovarian cancer stage at diagnosis among cases identified through the National Cancer Database A. Beckmeyer-Borowkoa, K.C. Brewera, C.E. Petersona,b, M.A. Otooa,c, F. Davisd, K. Hoskinsc, C.E. Joslina,b,c. aUniversity of Illinois at Chicago School of Public Health, Chicago, IL, USA, bUniversity of Illinois at Chicago Cancer Center, Chicago, IL, USA, cUniversity of Illinois College of Medicine, Chicago, IL, USA, dUniversity of Alberta School of Public Health, Edmonton, AB, Canada Objectives: Past research is inconclusive regarding racial differences in stage at diagnosis between non-Hispanic black (NHB) and nonHispanic white (NHW) women with epithelial ovarian cancer. The purpose of this analysis was to determine whether racial differences in stage at diagnosis were present in women diagnosed with ovarian cancer in the United States and Puerto Rico between 1998 and 2011 and to assess whether differences changed over time. Methods: NHW and NHB cases reported in the National Cancer Database (NCDB) were analyzed to evaluate differences in stage at diagnosis. Stage was dichotomized as early (stages I and II) vs. late (stages III and IV), and year of diagnosis was analyzed in three periods (1998–2002, 2003–2007, 2008–2011). Chi square was used to test differences between demographic and clinical factors (age, income, education, insurance status, facility location, tumor grade, period of diagnosis) and stage at diagnosis. Multivariable logistic regression was used to estimate the adjusted odds ratio (OR) and 95% CI for the association between race and late stage at diagnosis. Interaction between race and year of diagnosis was tested in the final model. Results: A total of 142,088 (92.2%) NHW and 12,086 (7.8%) NHB women were analyzed. NHB women had a significantly higher odds of late-stage diagnosis than NHW women (ORadj = 1.34, 95%CI 1.27–1.41). Interaction between race and period of diagnosis was statistically significant (P = 0.04), with disparities decreasing over time (OR and 95% CI, 1998–2002: 1.49, 1.36–1.63; 2003–2007: 1.33, 1.22–1.45; 2008–2011: 1.21, 1.11–1.32). Conclusions: Results indicate that within NCDB, NHB women are more likely to be diagnosed with late-stage ovarian cancer, yet these differences are decreasing with time. These findings of improved black-white differences in stage at diagnosis could be due, in part, to
improved access to care. Results may be underestimated because NCDB reflects approximately 70% of United States cases annually, generally including higher-tier, Commission on Cancer (CoC)approved hospitals, whose members may have changed over time. doi:10.1016/j.ygyno.2015.01.258
256 — Poster Session Oral contraceptive use and reproductive characteristics affect survival in patients with epithelial ovarian cancer N.V. Kolomeyevskaya, G. Zirpoli, M. Ruszczyk, K.S. Grzankowski, S.B. Lele, K.O. Odunsi, K. Moysich. Roswell Park Cancer Institute, Buffalo, NY, USA Objectives: Prognostic risk factors influencing survival in patients with epithelial ovarian cancer (EOC) include tumor stage, grade, histologic subtype, debulking status, and platinum sensitivity. Little is known about the impact of the hormonal milieu and reproductive factors before cancer diagnosis on clinical outcome. We sought to evaluate whether oral contraceptive (OC) use, gravidity, and parity have any prognostic significance on overall survival (OS) in patients with EOC. Methods: We included 387 patients with EOC, fallopian, and primary peritoneal cancers treated from 1982 to 1998 who completed a comprehensive epidemiologic questionnaire. Retrospective chart review was performed to abstract clinicopathologic data. OS was determined; Kaplan–Meier analysis was performed to compare survival across categorical exposures with differences tested using the log-rank test, while continuous variables were analyzed with Cox regression. Cox regression model was used to compute adjusted hazard ratios (aHRs) and 95% CIs. Results: After adjusting for age at diagnosis, stage, and histologic subtype, decreased risk of death was observed in women who reported prior use of OC (aHR 0.79, 95% CI 0.58–1.09), previous pregnancy (aHR 0.77, 95% CI 0.57–1.04), or a live birth (aHR 0.81, 95% CI 0.60–1.08). OC use was associated with a crude reduced risk of death (HR 0.55, 95% CI 0.42–0.72), with reported median OS of 81 months in OC users compared with 46 months in nonusers. Patients who reported a single live birth experienced the largest potential survival advantage (aHR 0.61, 95% CI 0.39–0.94). OC use and prior pregnancy were associated with improved survival across all histologic subtypes, stages, and grades. Conclusions: Our findings suggest that OC use, gravidity, and parity may have long-lasting effects on epithelial ovarian tumor characteristics conferring favorable prognosis. Putative mechanisms may stem from complex interactions between ovarian cells, host immune cells, and hormonal microenvironment during carcinogenesis that ultimately affect tumor biology. Future efforts should be directed at determining the role of host reproductive factors in antitumor immunity. doi:10.1016/j.ygyno.2015.01.259
257 — Poster Session Diagnostic value of combined 18F-FDG positron emission tomography/computed tomography in recurrent epithelial ovarian cancer with non-disseminated lesions: Correlation with pathologic diagnosis of the secondary cytoreduction P.S. Jung, S.W. Lee, J.Y. Park, D.S. Suh, D.Y. Kim, J.H. Kim, Y.M. Kim, Y.T. Kim, J.H. Nam. University of Ulsan College of Medicine, ASAN Medical Center, Seoul, South Korea Objectives: To evaluate the diagnostic accuracy of combined 18Ffluoro-2-deoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) imaging in suspected recurrence of