Diurnal cortisol and survival in epithelial ovarian cancer

Andrew Schrepf; Premal H Thaker; Michael J Goodheart; David Bender; George M Slavich; Laila Dahmoush; Frank Penedo; Koen DeGeest; Luis Mendez; David M Lubaroff; Steven W Cole; Anil K Sood; Susan K Lutgendorf

doi:10.1016/j.psyneuen.2015.01.010

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Diurnal cortisol and survival in epithelial ovarian cancer

Journal article

Open access

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Diurnal cortisol and survival in epithelial ovarian cancer

Andrew Schrepf, Premal H Thaker, Michael J Goodheart, David Bender, George M Slavich, Laila Dahmoush, Frank Penedo, Koen DeGeest, Luis Mendez, David M Lubaroff, …

Psychoneuroendocrinology, Vol.53, pp.256-267

03/2015

DOI: 10.1016/j.psyneuen.2015.01.010

PMCID: PMC4440672

PMID: 25647344

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Abstract

•We examine the role of hypothalamic-pituitary-adrenal axis in survival in ovarian cancer.•Blunted diurnal cortisol rhythms are associated with decreased survival.•Blunted diurnal cortisol rhythms are associated with tumor-associated inflammation.•Elevated night salivary cortisol marks dysregulated rhythms. 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. 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. 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). 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.

Inflammation

Hydrocortisone

Chronobiology disorders

Biological markers

Ovarian neoplasms

Details

Title: Subtitle: Diurnal cortisol and survival in epithelial ovarian cancer
Creators: Andrew Schrepf - Department of Psychology, University of Iowa, E11 Seashore Hall, Iowa City, IA 52242, USA
Premal H Thaker - Division of Gynecologic Oncology, Washington University School of Medicine, Maternity Building-660 South Euclid, Campus Box 8064, St. Louis, MO 63110, USA
Michael J Goodheart - Department of Obstetrics and Gynecology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
David Bender - Department of Obstetrics and Gynecology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
George M Slavich - Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, 300 Medical Plaza Driveway, Los Angeles, CA 90095, USA
Laila Dahmoush - Department of Urology, University of Iowa, 3 Roy Carver Pavilion, 200 Hawkins Dr, Iowa City, IA 52242, USA
Frank Penedo - Department of Medical Social Sciences, Northwestern University, 633 N. Saint Clair St., 19th Floor, Chicago, IL 60611, USA
Koen DeGeest - Division of Gynecologic Oncology, Oregon Health & Science University, Center for Women's Health, Kohler Pavilion, 7th Floor, 808 S.W. Campus Drive, Portland, OR 97239, USA
Luis Mendez - Department of Obstetrics and Gynecology, Florida International University School of Medicine, 5000 University Dr, Coral Gables, FL 33146, USA
David M Lubaroff - Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, USA
Steven W Cole - Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, 300 Medical Plaza Driveway, Los Angeles, CA 90095, USA
Anil K Sood - Department of Gynecologic Oncology, UT MD Anderson Comprehensive Cancer Center, 1155 Herman Pressler, Unit Number: 1362, Houston, TX 77030, USA
Susan K Lutgendorf - Department of Psychology, University of Iowa, E11 Seashore Hall, Iowa City, IA 52242, USA
Resource Type: Journal article
Publication Details: Psychoneuroendocrinology, Vol.53, pp.256-267
DOI: 10.1016/j.psyneuen.2015.01.010
PMID: 25647344
PMCID: PMC4440672
NLM abbreviation: Psychoneuroendocrinology
ISSN: 0306-4530
eISSN: 1873-3360
Publisher: Elsevier Ltd
Language: English
Date published: 03/2015
Academic Unit: Psychological and Brain Sciences; Pathology; Iowa Neuroscience Institute; Obstetrics and Gynecology; Urology
Record Identifier: 9983931820102771

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