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A Detailed Study of Patients and Tumor Characteristics of Epithelial Ovarian Cancer in Saudi Women
ISMAIL AL-BADAWI, MB;ChB, FRCSCChairman
Department of Obstetrics & GynecologyKFSH & RC
Associate Professor, AlFaisal University
Epithelial ovarian cancer (EOC)
The second most common gynecological cancer
The most lethal gynecological cancer
The life time risk of developing ovarian cancer in women is 1 in 70
The mean age of the diagnosis is mid-fifties
The incidence increases with age up to 80 and then declines
30 to 50UnknownFamilial ovarian cancer syndrome5.5 if first
degree (15)4.6Two or three relatives with
ovarian cancer3.7 if first degree (5)3.1
One relative (first or second degree) with ovarian cancer
1.81.0No risk factors0.80.65Past oral contraceptive use0.60.5Past pregnancy
2.8Infertility
1.6Nulligravidity0.81Past breast feeding0.59Tubal ligation
Risk factors Relative risk Life time probability %
Background:
According to the National Cancer Registry in the Kingdom of Saudi Arabia, ovarian cancer is the fifth most common cancer diagnosed in women representing 4.9% of all cancer cases diagnosed during 2010.
Detailed descriptive data regarding the clinical course of this disease among Saudi women is largely unknown.
1. Saudi Medical Journal, 2002. Ovarian diseases in KAUH
A study analysed 242 women underwent oophorectomy
72 ( 29.7%) cases Tumors
20 ( 14.4%) cases
Metastatic Carcinoma Papilary Serous Carcinoma
Until now no data published about EOC among Saudi women
Saudi Arabia tumor registry Ovarian cancer( all types)
6th the most common cancer among females in Saudi Arabia
The most common H/P type Papillary Serous Serous carcinoma
20042003200220011999-2000
Year
Ovarian cancer
108(3.1%)
109(3.4%)
96(3.3%)
101(3.7%)
205( 3.6%)
Newly diagnosed
( SA)
5145484846Mean age
27.824.817.720.827.8
Stage distribution
I (%)
13.07.320.810.915.6II (%)
46.360.650.053.541.5III, IV (%)
13.07.311.51415.1Unstaged (%)
Saudi society
Intermarrieges
Multiparity
Are our demographic, reproductive or environmental features different than in the population of the rest of
the world and if they are; how they affect behavior of EOC ?
http://images.google.com.sa/imgres?imgurl=http://medicineworld.org/images/blogs/4-2008/stem-cell-talk-57210.jpg&imgrefurl=http://medicineworld.org/cancer/lead/4-2008/ovarian-cancer-stem-cells-identified.html&h=244&w=254&sz=11&hl=ar&start=7&um=1&usg=__neaXzZ74YZC-S-80lQrwtoEkm00=&tbnid=pO8jAPoIElxuuM:&tbnh=107&tbnw=111&prev=/images%3Fq%3Depithelial%2Bovarian%2Bcancer%26gbv%3D2%26um%3D1%26hl%3Dar%26sa%3DNhttp://images.google.com.sa/imgres?imgurl=http://medicineworld.org/images/blogs/4-2008/stem-cell-talk-57210.jpg&imgrefurl=http://medicineworld.org/cancer/lead/4-2008/ovarian-cancer-stem-cells-identified.html&h=244&w=254&sz=11&hl=ar&start=7&um=1&usg=__neaXzZ74YZC-S-80lQrwtoEkm00=&tbnid=pO8jAPoIElxuuM:&tbnh=107&tbnw=111&prev=/images%3Fq%3Depithelial%2Bovarian%2Bcancer%26gbv%3D2%26um%3D1%26hl%3Dar%26sa%3DN
Retrospective review1997-2006
Identified 256 Saudi women treated in KFSH & RC
63 were excludedNon-Saudi
Lack of data
193 Saudi women with invasive EOC were analysed
Materials & Methods
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Log rank testKaplan Meier curves Impact of various
prognostic factors
Statistical Analysis
Progression Free Survival
ResultsPatients Characteristics
N=193
Age median 55.1 years (19-92)
BMI median 27.7, mean 27.2 (13.9-44.9)
# Pregnancies median 7.0, mean 6.4 (0-15)
Marital Status
Married 145 Divorced 7Single 12 Widowed 29
Family History 4 ( 2.1%)
Patients Characteristics ( contd)
Family History:
Four patients (2.1%) only reported family history of cancer including breast cancer (n=2), lymphoma (n=1), and ovarian cancer (n=1).
Unknown (n=27)
0 20 40 60 80 100 120 140
Unknown
Stage IV
Stage III
Stage II
Stage I6.2%
.5%
67.4%
5.7%
20.2%
FIGO Stage at Diagnosis
Serous Mucinous EndometrioidClear Cell Mixed Undifferentiated
64.8%19.2%
11.4% 2%
Distribution by Histology
Distribution by Grade
Grade 1 Grade 2 Grade 3
22%
41%
37%
Surgery only- 43 patients
Surgery followed by chemo- 131 patients
Chemo followed by surgery- 18 patients
Chemo only- 1 patient
152 patients had their surgery at KFSHRC 5 patients had secondary debulking surgeries
Treatments rendered
CHEMO_TX Frequency Percent Cumulative Frequency
Cumulative Percent
None 43 22.28 43 22.28
Others 2 1.04 45 23.32
Platinum only 9 4.66 54 27.98
Platinum+CTX 24 12.44 78 40.41
Platinum+Taxol 115 59.59 193 100.00
Median # of cycles = 6 (1-12)
Chemotherapy Regimens
tc "Table CHEMO_TY " \f C \l 2
tc "One-Way Frequencies " \f C \l 3CHEMO_TX
Frequency
Percent
CumulativeFrequency
CumulativePercent
None
43
22.28
43
22.28
Others
2
1.04
45
23.32
Platinum only
9
4.66
54
27.98
Platinum+CTX
24
12.44
78
40.41
Platinum+Taxol
115
59.59
193
100.00
Table 3
Results:
. One hundred twenty-seven patients (66%) experienced disease progression or recurrence after primary therapy.
Median progression-free survival from end of chemotherapy to recurrence/progression was 11.9 months (95% confidence interval, 9.4-15.2).
PFS by Age
PFS by Pregnancy #
Progression free survival
Parity
> 10 pregnancies( 13.4%)
< 10 pregnancies( 86.5%)
16.0 months 17.1 months
p = 0.02
PFS by Stage
PFS by Residual disease
Progression free survival
Residual disease
Optimal debulking
Suboptimal debulking
22 months 13.5 months
( p = 0.001)Statisticaly significant
PFS by Treatment
The large majority of Saudi women with EOC present with advanced stage disease
Despite the high rate of imtermarriages, reported family history of cancer was low in our study population
High parity had no significant clinical impact on prognosis, except more than 10 children
The local Saudi data concur with the international data
Conclusion
Strengths:
this is the first study evaluating EOC in Saudi patients.
central pathologic review of all cases
relatively large cohort of patients
Limitations:Non-compliance in regular follow-up in our gynecologic oncology clinics in up to 25% of patients
Inability to contact the patients from different districts around Saudi Arabia.
The overall survival could not be calculated/reported in this study owing to the lack of accurate information available about the patients date of death (if it occurred).
Thank you
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