Survival in Advanced Epithelial Ovarian Cancer Associated with Cardiovascular Comorbidities and Type 2 Diabetes Mellitus

Abstract

Background: Ovarian carcinoma (OC) is usually diagnosed at an advanced stage, necessitating a multimodal approach that includes surgery and systemic therapy. The incidence of OC is approximately five times higher in women over 65 years of age. Cardiovascular comorbidities and type 2 diabetes mellitus, both prevalent at this age, can influence therapeutic strategy and have an adverse effect on survival. Objectives: Our study aimed to determine the impact of cardiovascular diseases and diabetes mellitus on survival in advanced ovarian cancer. Materials and methods: From 2004 to 2012, we retrospectively studied 104 patients with advanced epithelial ovarian cancer (FIGO stage II–IV) who underwent surgical treatment at the Gynecology Clinic, St. Anna University Hospital, Varna, Bulgaria. Patients were followed for an average of 90 (52–129) months. We divided the study population into two groups: those with concurrent cardiovascular diseases and type 2 diabetes mellitus (CVD) and those without these comorbidities (No-CVD group). Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were compared between groups using Kaplan–Meier survival analysis. Cardiovascular comorbidities and diabetes mellitus were evaluated for their prognostic value for survival using multivariate Cox proportional regression analysis adjusted for age, stage of OC, grade and histological type of the tumor, ascites presence, residual tumor size (RT), performance status, and type of hysterectomy. Results: The Kaplan–Meier analysis showed reduced OS and DSS in the CVD group compared to the No-CVD group. The median OS was 24.5 months (95% CI 18.38 months) and 38 months (95% CI 26, not reached), respectively (Log-rank p = 0.045). The median DSS was 25.5 months (95% CI 19.39 months) and 48 months (95% CI 28, not reached), respectively (Log-rank p = 0.033). The Cox regression multivariate analysis established a lower (by 68%) overall survival rate for the CVD patient group than the No-CVD group, approaching statistical significance (HR 1.68, 95% CI 0.99, 2.86, p = 0.055). Cardiovascular diseases and diabetes were associated with a 79% reduction in DSS (HR 1.79, 95% CI 1.02, 3.13, p = 0.041) and a twofold increase in the risk of disease progression (HR 2.05, 95% CI 1.25, 3.37, p = 0.005). Conclusions: According to our study, cardiovascular comorbidities and diabetes may adversely affect OC survival. Optimal control of cardiovascular diseases, diabetes mellitus, and their risk factors may be beneficial for patients with advanced OC. Further research involving a larger patient population is necessary to establish these comorbidities as independent prognostic factors.

Impact of Diabetes on Short-Term and Long-Term Outcomes of Ampullary Adenocarcinoma Patients after Curative Pancreatoduodenectomy

“…In addition, we found that diabetes was an independent risk factor for recurrence, especially for systemic recurrence. The similar results were previously reported in the epithelial ovarian cancer [ 10 , 17 ], pancreatic cancer [ 8 , 18 ], breast cancer [ 7 ], gallbladder cancer [ 9 ], colorectal cancer [ 13 , 19 , 20 ], and non-small-cell lung cancer [ 15 ]. However, the exact mechanism of how diabetes affects the prognosis of AC patients who underwent curative pancreaticoduodenectomy remains unclear.…”

Predictive value of the Adult Comorbidity Evaluation 27 on adverse surgical outcomes and survival in elderly with advanced epithelial ovarian cancer undergoing cytoreductive surgery

“…Our data showed that comorbidities of higher ACE-27 score (moderate and severe) signi cantly increase the risk for adverse outcomes after cytoreductive surgery in elderly women with AEOC. Despite the existence of evidence demonstrating the relevance between comorbidity and survival in ovarian cancer [20], there were also studies in which no such difference was presented [8]. In the present study, overall survival of the severe ACE-27 grade was signi cantly worse than that of the none, mild, or moderate (p = 0.004).…”

“…Due to the extra attention the cancer patients receive, the incidence of comorbidities may be higher than that in non-cancer patients [19]. Several studies have suggested an in uential role of comorbidities in process of ovarian cancer treatment [20,21], but more objective evaluation tools were seldom employed. Being different from the classical comorbidity assessment tool CCI, which simply sums up all items, ACE-27 classi es comorbidities based on their severity.…”

Predictive value of the Adult Comorbidity Evaluation 27 on adverse surgical outcomes and survival in elderly with advanced epithelial ovarian cancer undergoing cytoreductive surgery

“…Studies concerning the frailty index demonstrated that comorbidities as well as functional status, are associated with worse surgical outcomes and poorer OS [ 20 , 21 ]. An array of studies have suggested an influential role of comorbidities in the process of ovarian cancer treatment [ 22 , 23 ], though the incorporation more objective evaluative tools remains limited. In contrast to the classical comorbidity assessment tool CCI, which aggregates all items irrespective of severity, ACE-27 methodically categorizes comorbidities based on their severity.…”