Diurnal cortisol and survival in epithelial ovarian cancer

PSYCHONEUROENDOCRINOLOGY

卷:53

Article

Schrepf, Andrew¹  Thaker, Premal H.²  Goodheart, Michael J.^3,4  Bender, David³  Slavich, George M.^5,6  Dahnnoush, Laila^7,8  Penedo, Frank^9,10  DeGeest, Koen¹¹  Mendez, Luis¹²  Lubaroff, David M.^6,13,14  Cole, Steven W.^5,6,15  Sood, Anil K.^16,17  Lutgendorf, Susan K.^1,3,7,14 

[1] Univ Iowa, Dept Psychol, Iowa City, IA 52242 USA

[2] Washington Univ, Sch Med, Div Gynecol Oncol, St Louis, MO 63110 USA

[3] Univ Iowa, Dept Obstet & Gynecol, Iowa City, IA 52242 USA

[4] Univ Iowa, Dept Anat & Cell Biol, Iowa City, IA 52242 USA

[5] Univ Calif Los Angeles, Cousins Ctr Psychoneuroimmunol, Los Angeles, CA 90095 USA

[6] Univ Calif Los Angeles, Dept Psychiat & Biobehav Sci, Los Angeles, CA 90095 USA

[7] Univ Iowa, Dept Urol, Iowa City, IA 52242 USA

[8] Univ Iowa, Dept Pathol, Iowa City, IA 52242 USA

[9] Northwestern Univ, Dept Med Social Sci, Chicago, IL 60611 USA

[10] Northwestern Univ, Dept Psychiat & Behav Sci, Chicago, IL 60611 USA

[11] Oregon Hlth & Sci Univ, Ctr Womens Hlth, Div Gynecol Oncol, Portland, OR 97239 USA

[12] Florida Int Univ, Sch Med, Dept Obstet & Gynecol, Coral Gables, FL 33146 USA

[13] Univ Iowa, Dept Microbiol, Iowa City, IA 52242 USA

[14] Univ Iowa, Holden Comprehens Canc Ctr, Iowa City, IA 52242 USA

[15] Univ Calif Los Angeles, Sch Med, Dept Med, Los Angeles, CA 90095 USA

[16] UT MD Anderson Comprehens Canc Ctr, Dept Gynecol Oncol, Houston, TX 77030 USA

[17] UT MD Anderson Comprehens Canc Ctr, Dept Canc Biol, Houston, TX 77030 USA

关键词: Ovarian neoplasms;    Inflammation;    Hydrocortisone;    Chronobiology disorders;    Biological markers;   

DOI  :  10.1016/j.psyneuen.2015.01.010

来源: Elsevier

【 摘 要 】

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. (C) 2015 Elsevier Ltd. All rights reserved.

【 授权许可】

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