Diurnal cortisol and survival in epithelial ovarian cancer.
|Title||Diurnal cortisol and survival in epithelial ovarian cancer.|
|Publication Type||Journal Article|
|Year of Publication||2015|
|Authors||Schrepf A, Thaker PH, Goodheart MJ, Bender D, Slavich GM, Dahmoush L, Penedo F, DeGeest K, Mendez L, Lubaroff DM, Cole SW, Sood AK, Lutgendorf SK|
|Date Published||2015 Mar|
|Keywords||Aged, Ascitic Fluid, Circadian Rhythm, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Inflammation, Interleukin-6, Middle Aged, Neoplasms, Glandular and Epithelial, Ovarian Neoplasms, Pituitary-Adrenal System, Prognosis, Proportional Hazards Models, Saliva|
INTRODUCTION: Hypothalamic-pituitary-adrenal (HPA) deregulation is commonly observed in cancer patients, but its clinical significance is not well understood. We prospectively examined the association between HPA activity, tumor-associated inflammation, and survival in ovarian cancer patients prior to treatment.
MATERIALS AND METHODS: Participants were 113 women with ovarian cancer who provided salivary cortisol for three days prior to treatment for calculation of cortisol slope, variability, and night cortisol. Cox proportional hazard regression analyses were used to examine associations between cortisol and survival in models adjusting for disease stage, tumor grade, cytoreduction and age. On a subsample of 41 patients with advanced disease ascites fluid was assayed for levels of interleukin-6 (IL-6) and correlated with cortisol variables.
RESULTS: Each cortisol measure was associated with decreased survival time, adjusting for covariates (all p<.041). A one standard deviation increase in night cortisol was associated with a 46% greater likelihood of death. Patients in the high night cortisol group survived an estimated average of 3.3 years compared to 7.3 years for those in the low night cortisol group. Elevated ascites IL-6 was associated with each cortisol measure (all r>36, all p<.017).
DISCUSSION: Abnormal cortisol rhythms assessed prior to treatment are associated with decreased survival in ovarian cancer and increased inflammation in the vicinity of the tumor. HPA abnormalities may reflect poor endogenous control of inflammation, dysregulation caused by tumor-associated inflammation, broad circadian disruption, or some combination of these factors. Nocturnal cortisol may have utility as a non-invasive measure of HPA function and/or disease severity.
|PubMed Central ID||PMC4440672|
|Grant List||CA104825 / CA / NCI NIH HHS / United States |
CA109298 / CA / NCI NIH HHS / United States
CA116778 / CA / NCI NIH HHS / United States
CA140933 / CA / NCI NIH HHS / United States
CA88293 / CA / NCI NIH HHS / United States
K08 MH103443 / MH / NIMH NIH HHS / United States
P50 CA083639 / CA / NCI NIH HHS / United States
P50CA083639 / CA / NCI NIH HHS / United States
R01 CA104825 / CA / NCI NIH HHS / United States
R01 CA109298 / CA / NCI NIH HHS / United States
R01 CA110793 / CA / NCI NIH HHS / United States
R01 CA140933 / CA / NCI NIH HHS / United States