Pre-diagnostic serum levels of inflammation markers and risk of ovarian cancer in the prostate, lung, colorectal and ovarian cancer (PLCO) screening trial

Gynecol Oncol. 2014 Nov;135(2):297-304. doi: 10.1016/j.ygyno.2014.08.025. Epub 2014 Aug 23.


Objective: Pro-inflammatory mechanisms may explain the increased ovarian cancer risk linked to more lifetime ovulations, endometriosis, and exposure to talc and asbestos, as well as decreased risk with non-steroidal anti-inflammatory drugs. Limited data are available to estimate ovarian cancer risk associated with levels of circulating inflammatory markers.

Methods: We conducted a nested case-control study within the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Pre-diagnostic serum levels of 46 inflammation-related biomarkers (11 with a priori hypotheses; 35 agnostic) were measured in 149 incident ovarian cancer cases and 149 matched controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression and adjusted for identified covariates.

Results: Increased ovarian cancer risk was associated with elevated levels of C-reactive protein (CRP) [tertile (T)3 vs. T1: OR (95% CI) 2.04 (1.06-3.93), p-trend=0.03], interleukin (IL)-1α [detectable vs. undetectable: 2.23 (1.14-4.34)] and tumor necrosis factor alpha (TNF-α) [T3 vs. T1: 2.21 (1.06-4.63), p-trend=0.04]. Elevated IL-8 was non-significantly associated with risk [T3 vs. T1: 1.86 (0.96-3.61), p-trend=0.05]. In analyses restricted to serous ovarian cancer (n=83), the associations with CRP and IL-8 remained or strengthened [CRP T3 vs. T1: 3.96 (1.14-11.14), p-trend=0.008; IL-8 T3 vs. T1: 3.05 (1.09-8.51), p-trend=0.03]. Elevated levels of CRP and TNF-α remained positively associated with ovarian cancer risk in analysis restricted to specimens collected at least 5years before diagnosis (n=56).

Conclusion: These results suggest that CRP, IL-1α, IL-8, and TNF-α are associated with increased risk of subsequently developing ovarian cancer.

Keywords: Circulating inflammation markers; Cytokines; Inflammation; Nested case–control study; Ovarian cancer; Pre-diagnostic.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Aged
  • Biomarkers, Tumor / blood
  • Biomarkers, Tumor / immunology*
  • C-Reactive Protein / immunology*
  • Carcinoma, Ovarian Epithelial
  • Case-Control Studies
  • Early Detection of Cancer
  • Female
  • Humans
  • Inflammation / blood
  • Interleukin-1alpha / immunology*
  • Interleukin-8 / immunology*
  • Logistic Models
  • Middle Aged
  • Neoplasms, Glandular and Epithelial / blood
  • Neoplasms, Glandular and Epithelial / immunology*
  • Odds Ratio
  • Ovarian Neoplasms / blood
  • Ovarian Neoplasms / immunology*
  • Risk
  • Tumor Necrosis Factor-alpha / immunology*


  • Biomarkers, Tumor
  • CXCL8 protein, human
  • IL1A protein, human
  • Interleukin-1alpha
  • Interleukin-8
  • Tumor Necrosis Factor-alpha
  • C-Reactive Protein