Recurrence Season Impacts the Survival of Epithelial Ovarian Cancer Patients

  • Liu, Xiao-Hui (Zhong-Shan-Men In-patient Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Center for Cancer, Key Laboratory of Cancer Prevention and Therapy) ;
  • Man, Ya-Nan (Zhong-Shan-Men In-patient Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Center for Cancer, Key Laboratory of Cancer Prevention and Therapy) ;
  • Wu, Xiong-Zhi (Zhong-Shan-Men In-patient Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Center for Cancer, Key Laboratory of Cancer Prevention and Therapy)
  • Published : 2014.02.28


Background: Several studies indicated that the diagnosis season affects the prognosis of some cancers, such as examples in the prostate, colon and breast. This retrospective study aimed to investigate whether the diagnosis and recurrent season impacts the prognosis of epithelial ovarian cancer patients. Methods: From January 2005 to August 2010, 161 epithelial ovarian cancer patients were analyzed and followed up until August 2013. Kaplan-Meier survival curves and the log-rank test were used to make the survival analysis. Multivariate analysis was conducted to identify independent prognostic factors. Results: The prognostic factors of overall survival in epithelial ovarian cancer patients included age, clinical stage, pathological type, histological grade, residual disease after primary surgery, recurrent season and adjuvant chemotherapy cycles. Moreover, clinical stage, histological grade, residual disease after primary surgery, recurrent season and adjuvant chemotherapy cycles also impacted the progression-free survival of epithelial ovarian cancer patients. The diagnosis season did not have a significantly relationship with the survival of operable epithelial ovarian cancer patients. Median overall survival of patients with recurrent month from April to November was 47 months, which was longer (P < 0.001) than that of patients with recurrence month from December to March (19 months). Median progression-free survival of patients with recurrence month from April to November and December to March was 20 and 8 months, respectively (P < 0.001). Conclusion: The recurrence season impacts the survival of epithelial ovarian cancer patients. However, the diagnosed season does not appear to exert a significant influence.


  1. Tuohimaa P, Pukkala E, Scelo G, et al (2007). Does solar exposure, as indicated by the non-melanoma skin cancers, protect from solid cancers: vitamin D as a possible explanation. Eur J Cancer, 43, 1701-12.
  2. Turna A, Pekcolaklar A, Metin M, Yaylim I, Gurses A (2012). The effect of season of operation on the survival of patients with resected non-small cell lung cancer. Interact Cardiovasc Thorac Surg, 14, 151-5.
  3. Vik T, Try K, Stromme JH (1980). The vitamin D status of man at 70 degrees north. Scand J Clin Lab Invest, 40, 227-32.
  4. Porojnicu AC, Robsahm TE, et al (2007). Seasonal and geographical variations in lung cancer prognosis in Norway. Does Vitamin D from the sun play a role? Lung Cancer, 55, 263-70.
  5. Porojnicu A, Robsahm TE, Berg JP, Moan J (2007). Season of diagnosis is a predictor of cancer survival. Sun-induced vitamin D may be involved: a possible role of sun-induced Vitamin D. J Steroid Biochem Mol Biol, 103, 675-8.
  6. Porojnicu AC, Dahlback A, Moan J (2008). Sun exposure and cancer survival in Norway: changes in the risk of death with season of diagnosis and latitude. Adv Exp Med Biol, 624, 43-54.
  7. Porojnicu AC, Lagunova Z, et al (2007). Changes in risk of death from breast cancer with season and latitude: sun exposure and breast cancer survival in Norway. Breast Cancer Res Treat, 102, 323-8.
  8. Poskitt EM, Cole TJ, Lawson DE (1979). Diet, sunlight, and 25-hydroxy vitamin D in healthy children and adults. Br Med J, 1, 221-3.
  9. Robsahm TE, Tretli S, Dahlback A, Moan J (2004). Vitamin D3 from sunlight may improve the prognosis of breast-, colonand prostate cancer (Norway). Cancer Causes Control, 15, 149-58.
  10. Roychoudhuri R, Robinson D, Coupland V, Holmberg L, Moller H (2009). Season of cancer diagnosis exerts distinct effects upon short- and long-term survival. Int J Cancer, 124, 2436-41.
  11. Salazar-Martinez E, Lazcano-Ponce EC, Gonzalez LG, Escudero-De LRP, Hernandez-Avila M (2002). Nutritional determinants of epithelial ovarian cancer risk: a case-control study in Mexico. Oncology, 63, 151-7.
  12. Siegel R, Naishadham D, Jemal A (2013). Cancer statistics, 2013. CA Cancer J Clin, 63, 11-30.
  13. Thigpen T, Brady MF, Omura GA, et al (1993). Age as a prognostic factor in ovarian carcinoma. The Gynecologic Oncology Group experience. Cancer, 71, 606-14.
  14. Mainio A, Hakko H, Koivukangas J, Niemela A, Rasanen P (2006). Winter birth in association with a risk of brain tumor among a Finnish patient population. Neuroepidemiology, 27, 57-60.
  15. Lefkowitz ES, Garland CF (1994). Sunlight, vitamin D, and ovarian cancer mortality rates in US women. Int J Epidemiol, 23, 1133-6.
  16. Liigant A, Kulla A, Linnamagi U, Asser T, Kaasik AE (2001). Survival of patients with primary CNS tumours in Estonia. Eur J Cancer, 37, 1895-903.
  17. Lim HS, Roychoudhuri R, Peto J, et al (2006). Cancer survival is dependent on season of diagnosis and sunlight exposure. Int J Cancer, 119, 1530-6.
  18. Mehta RG, Mehta RR (2002). Vitamin D and cancer. J Nutr Biochem, 13, 252-64.
  19. Mizoue T (2004). Ecological study of solar radiation and cancer mortality in Japan. Health Phys, 87, 532-8.
  20. Moan J, Porojnicu AC, Robsahm TE, et al (2005). Solar radiation, vitamin D and survival rate of colon cancer in Norway. J Photochem Photobiol B, 78, 189-93.
  21. Mosekilde L, Nielsen LR, Larsen ER, Moosgaard B, Heickendorff L (2005). [Vitamin D deficiency. Definition and prevalence in Denmark]. Ugeskr Laeger, 167, 29-33.
  22. Mutlu H, Akca Z, Cihan YB, et al (2013). Is season a prognostic factor in breast cancer? Asian Pac J Cancer Prev, 14, 743-6.
  23. Oguz A, Unal D, Kurtul N, et al (2013). Season of diagnosis and survival of advanced lung cancer cases - any correlation? Asian Pac J Cancer Prev, 14, 4325-8.
  24. Omura GA, Brady MF, Homesley HD, et al (1991). Long-term follow-up and prognostic factor analysis in advanced ovarian carcinoma: the Gynecologic Oncology Group experience. J Clin Oncol, 9, 1138-50.
  25. Heintz AP, Odicino F, Maisonneuve P, et al (2006). Carcinoma of the ovary. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet, 95, S161-92.
  26. Grant WB (2003). Ecologic studies of solar UV-B radiation and cancer mortality rates. Recent Results Cancer Res, 164, 371-7.
  27. Hakko H, Rasanen P, Niemela A, Koivukangas J, Mainio A (2009). Season of tumor surgery in relation to deaths among brain tumor patients: does sunlight and month of surgery play a role in brain tumor deaths? Acta Neurochir (Wien), 151, 1369-75.
  28. Hanchette CL, Schwartz GG (1992). Geographic patterns of prostate cancer mortality. Evidence for a protective effect of ultraviolet radiation. Cancer, 70, 2861-9.<2861::AID-CNCR2820701224>3.0.CO;2-G
  29. Hill C, Doyon F (2006). [The frequency of cancer in France in year 2002, and trends since 1968]. Bull Cancer, 93, 7-11.
  30. Hoskins WJ (1989). The influence of cytoreductive surgery on progression-free interval and survival in epithelial ovarian cancer. Baillieres Clin Obstet Gynaecol, 3, 59-71.
  31. Hoskins WJ, Bundy BN, Thigpen JT, Omura GA (1992). The influence of cytoreductive surgery on recurrence-free interval and survival in small-volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol, 47, 159-66.
  32. Hoskins WJ, McGuire WP, Brady MF, et al (1994). The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol, 170, 974-9, 979-80.
  33. Kizildag S, Ates H, Kizildag S (2010). Treatment of K562 cells with 1,25-dihydroxyvitamin D3 induces distinct alterations in the expression of apoptosis-related genes BCL2, BAX, BCLXL, and p21. Ann Hematol, 89, 1-7.
  34. Freedman DM, Dosemeci M, McGlynn K (2002). Sunlight and mortality from breast, ovarian, colon, prostate, and non- melanoma skin cancer: a composite death certificate based case-control study. Occup Environ Med, 59, 257-62.
  35. Bidoli E, La Vecchia C, Talamini R, et al (2001). Micronutrients and ovarian cancer: a case-control study in Italy. Ann Oncol, 12, 1589-93.
  36. Bouillon R, Eelen G, Verlinden L, et al (2006). Vitamin D and cancer. J Steroid Biochem Mol Biol, 102, 156-62.
  37. Garland CF, Mohr SB, Gorham ED, Grant WB, Garland FC (2006). Role of ultraviolet B irradiance and vitamin D in prevention of ovarian cancer. Am J Prev Med, 31, 512-4.
  38. Genkinger JM, Hunter DJ, Spiegelman D, et al (2006). Dairy products and ovarian cancer: a pooled analysis of 12 cohort studies. Cancer Epidemiol Biomarkers Prev, 15, 364-72.
  39. Goodman MT, Wu AH, Tung KH, et al (2002). Association of dairy products, lactose, and calcium with the risk of ovarian cancer. Am J Epidemiol, 156, 148-57.
  40. Grant WB (2002). An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer, 94, 1867-75.

Cited by

  1. Impact of Prognostic Factors on Survival Rates in Patients with Ovarian Carcinoma vol.15, pp.15, 2014,
  2. Intra-Peritoneal Cisplatin Combined with Intravenous Paclitaxel in Optimally Debulked Stage 3 Ovarian Cancer Patients: An Izmir Oncology Group Study vol.15, pp.15, 2014,
  3. Lack of Association between the COMT rs4680 Polymorphism and Ovarian Cancer Risk: Evidence from a Meta-analysis of 3,940 Individuals vol.15, pp.18, 2014,
  4. Impact of Preoperative Serum Levels of CA 125 on Epithelial Ovarian Cancer Survival vol.17, pp.4, 2016,
  5. Reduced Klotho expression contributes to poor survival rates in human patients with ovarian cancer, and overexpression of Klotho inhibits the progression of ovarian cancer partly via the inhibition of systemic inflammation in nude mice vol.15, pp.4, 2017,