Obesity in ovarian cancer prognosis

描述（由申请人提供）：卵巢癌是美国妇科恶性肿瘤死亡的主要原因。由于症状往往是非特异性的，早期发现是困难的，大多数卵巢癌是在晚期诊断时，预后很差。尽管如此，有临床证据表明，即使肿瘤特征相同，某些病例的生存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。特别是肥胖可能会延迟诊断，阻碍最佳的手术和细胞毒性治疗，并导致术后并发症。Kaiser Permanente北方加州（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几个方面的影响，包括检测，治疗和生存，因为它包括大量的人口，详细的实验室，临床和治疗信息。 我们建议进行一项回顾性队列研究，包括2000-2008年间诊断的约1,900例浸润性卵巢癌病例，以及KPNC成员至2010年的随访信息。我们的主要目的是研究体重指数（BMI）对卵巢癌生存率和CA-125水平的作用，CA-125是卵巢癌临床治疗中常规使用的肿瘤标志物。将使用多变量考克斯比例回归方法估计风险比和95%置信区间。我们还将使用多变量逻辑回归来评估BMI与CA-125升高（定义为>35 U/ml）之间的关联。我们的研究结果可能提供关键信息，以提高我们对卵巢癌预后因素的理解，并减少肥胖患者癌症护理质量的差异，最终目标是改善卵巢癌的临床管理，以减少卵巢癌死亡。 这项研究代表了R 01申请的第一步，该申请旨在对KPNC成员中的卵巢癌幸存者进行前瞻性队列研究，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，该研究还旨在提供癌症生存经验，以及熟悉KPNC文件和程序，并生成初步数据和出版物以支持R 01提案。K22奖的拟议计划将补充候选人的K 07奖提供的坚实基础，并为她提供在关键过渡阶段成为女性激素癌症营养流行病学的独立调查员和领先专家所需的额外保护时间，包括预防和生存。 公共卫生相关性：我们建议利用北方加州Kaiser Permanente系统提供的独特机会，评估过多体重和体重变化对卵巢癌预后的作用，该系统包括大量具有详细实验室和临床信息的人群。我们的研究有可能为卵巢癌的最佳管理提供关键信息，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.