Obesity in ovarian cancer prognosis

描述(申请人提供)：卵巢癌是美国妇科恶性肿瘤的主要死因。因为症状往往是非特异性的，所以很难及早发现，而且大多数卵巢癌是在预后较差的晚期被诊断出来的。尽管如此，有临床证据表明，即使考虑到相同的肿瘤特征，一些病例的存活率也比其他病例高得多。然而，人们对影响卵巢癌生存率的生活方式因素知之甚少。尤其是肥胖可能会延误诊断，阻碍最佳的手术和细胞毒性治疗，并导致术后并发症。Kaiser Permanente North California(KPNC)提供了一个独特的机会来评估肥胖和体重变化对卵巢癌临床管理的多个方面的影响，包括检测、治疗和生存，因为它包括大量拥有详细的实验室、临床和治疗信息的人群。 我们建议在KPNC成员中进行一项回顾性队列研究，包括2000-2008年间确诊的大约1900例侵袭性卵巢癌病例和2010年的随访信息。我们的主要目标是研究体重指数(BMI)对卵巢癌生存率和CA-125水平的影响，CA-125是卵巢癌临床治疗中常规使用的一种肿瘤标志物。将使用多变量Cox比例回归方法来估计危险比和95%的可信区间。我们还将使用多变量Logistic回归来评估BMI和升高的CA-125(定义为35 U/ml)之间的关联。我们的发现可能会提供关键信息，以提高我们对卵巢癌预后因素的理解，并减少肥胖患者在癌症护理质量方面的差异，最终目标是改善卵巢癌的临床管理，减少卵巢癌死亡。 这项研究是准备R01应用程序的第一步，以开发一项针对KPNC成员中卵巢癌幸存者的前瞻性队列研究，以研究影响生存的遗传和生活方式因素。除了解决重大问题外，这项研究的目的是提供癌症生存方面的经验，以及熟悉KPNC文件和程序，并产生初步数据和出版物来支持R01提案。拟议的K22奖计划将补充候选人的K07奖提供的坚实基础，并为她提供关键过渡阶段所需的额外保护时间，使她成为一名独立研究员和女性荷尔蒙癌症营养流行病学、跨越预防和生存方面的领先专家。 公共卫生相关性：我们建议利用北加州Kaiser Permanente系统提供的独特机会来评估超重体重和体重变化对卵巢癌预后的作用，该系统包括具有详细实验室和临床信息的大量人口。我们的研究有可能为卵巢癌的最佳治疗提供关键信息，最终目标是减少卵巢癌死亡。

DESCRIPTION (provided by applicant): Ovarian cancer is the leading cause of death from gynecologic malignancies in the United States. Because symptoms tend be nonspecific, early detection is difficult and most ovarian cancers are diagnosed at an advanced stage when the prognosis is poor. Nonetheless, there is clinical evidence that even given the same tumor characteristics, some cases experience much better survival than others. However, little is known about lifestyle factors affecting ovarian cancer survival. Obesity in particular may delay diagnosis, hinder optimal surgical and cytotoxic treatment, and cause postoperative complications. Kaiser Permanente Northern California (KPNC) offers a unique opportunity to evaluate the impact of obesity and weight changes on several aspects of ovarian cancer clinical management, including detection, treatment, and survival, as it comprises a large population with detailed laboratory, clinical, and treatment information. We propose to conduct a retrospective cohort study including approximately 1,900 invasive ovarian cancer cases diagnosed between 2000-2008 and follow-up information through 2010 among KPNC members. Our main objectives are to examine the role of body mass index (BMI) on ovarian cancer survival and on CA-125 levels, a tumor marker routinely used in the clinical management of ovarian cancer. Multivariate Cox Proportional Regression methods will be used to estimate hazard ratios and 95% confidence intervals. We will also use multivariate logistic regression to evaluate the association between BMI and elevated CA-125 (defined as >35 U/ml). Our findings may provide critical information to improve our understanding of ovarian cancer prognostic factors and to reduce disparities in the quality of cancer care in obese patients, with the ultimate goal of improving clinical management of ovarian cancer to reduce ovarian cancer deaths. This study represents the first step in the preparation of an R01 application to develop a prospective cohort study of ovarian cancer survivors among KPNC members to study genetic and lifestyle factors affecting survival. In addition to addressing significant issues, the study is designed to provide experience in cancer survivorship, as well as familiarity with KPNC files and procedures, and to generate preliminary data and publications to support the R01 proposal. The proposed plans for a K22 Award will complement the strong foundation provided by the candidate's K07 Award and afford her the additional protected time needed during her critical transition phase to become an independent investigator and a leading expert in the nutritional epidemiology of female hormonal cancers, spanning prevention and survival. PUBLIC HEALTH RELEVANCE: We propose to evaluate the role of excess body mass and changes in weight on ovarian cancer prognosis using the unique opportunity provided by the Kaiser Permanente of Northern California system, which includes a large population with detailed laboratory and clinical information. Our study has the potential to provide critical information for the optimal management of ovarian cancer with the ultimate goal of reducing ovarian cancer deaths.