Background: The role of previously diagnosed comorbidities in relation to prognosis for ovarian cancer patients has not been studied extensively, particularly examining histological subtype. We explored the association between pre-existing hypertension, heart disease, and diabetes and overall survival (OS) and progression-free survival (PFS) among women diagnosed with ovarian cancer in a large international study.

Methods: Using pooled data from 14 case-control studies participating in the Ovarian Cancer Association Consortium (n = 7076), we examined associations between self-reported pre-existing hypertension, heart disease, and diabetes, and OS and PFS among patients diagnosed with invasive epithelial ovarian carcinoma. We used Cox proportional hazards regression models adjusted for age and stage to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). We also examined associations separately for the main histological subtypes, high-grade serous, low-grade serous, mucinous, endometrioid, and clear cell tumors. Analyses were also conducted in strata of menopausal status, body mass index (BMI) categories, stage of disease, and ever use of medications specific for each condition.

Results: No significant associations were observed for overall cancer for risk of death with history of hypertension (n = 5847; HR = 0.93; 95% CI 0.85-1.02), history of heart disease (n = 4178; HR = 1.11; 95%CI 0.91-1.36) or history of diabetes (n = 7043; HR = 1.07; 95%CI 0.95-1.20). Similarly, there was no association of these comorbidities with PFS. However, among cases with endometrioid tumors, history of hypertension was associated with lower risk of both OS and PFS (n = 869; HR = 0.70; 95%CI 0.51-0.96, and n = 246, HR = 0.54; 95%CI 0.33-0.90 correspondingly). There were no significant associations observed between history of the comorbidities and PFS among the other histological subtypes. None of the examined associations differed in strata defined by menopausal status, BMI categories, stage of disease, or categories of medications intake.

Conclusion: Pre-existing hypertension may be inversely associated with survival among women diagnosed with invasive ovarian cancer, particularly for those with endometrioid tumors. Understanding of the mechanism for this observation could provide for treatment strategies. Future studies are needed to explore the role of chronic diseases and their management in relation to prognosis of ovarian cancer patients and investigate the difference of tumor microenvironment among various histologic subtypes.

Citation Format: Albina Minlikeeva, Jo L. Freudenheim, Kirsten B. Moysich, Ovarian Cancer Association Consortium. Cardiovascular comorbidity and ovarian cancer patient survival: history of hypertension, heart disease, and diabetes, evidence from the Ovarian Cancer Association Consortium. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2638.