Detailed study of epi ov ca in saudi
- 1. A Detailed Study of Patients and Tumor Characteristics of Epithelial Ovarian Cancer in Saudi Women ISMAIL AL-BADAWI, MB;ChB, FRCSC Chairman Department of Obstetrics & Gynecology KFSH & RC Associate Professor, AlFaisal University
- 3. 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
- 4. 30 to 50UnknownFamilial ovarian cancer syndrome 5.5 if first degree (15) 4.6 Two or three relatives with ovarian cancer 3.7 if first degree (5) 3.1 One relative (first or second degree) with ovarian cancer 1.81.0No risk factors 0.80.65Past oral contraceptive use 0.60.5Past pregnancy 2.8Infertility 1.6Nulligravidity 0.81Past breast feeding 0.59Tubal ligation Risk factors Relative risk Life time probability %
- 5. 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.
- 6. 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
- 7. •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
- 8. 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 (%)
- 9. •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 ?
- 10. Retrospective review 1997-2006 Identified 256 Saudi women treated in KFSH & RC 63 were excluded Non-Saudi Lack of data 193 Saudi women with invasive EOC were analysed Materials & Methods
- 11. Log rank test Kaplan Meier curves Impact of various prognostic factors Statistical Analysis Progression Free Survival
- 12. Results Patients 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)
- 13. • Marital Status Married 145 Divorced 7 Single 12 Widowed 29 • Family History 4 ( 2.1%) Patients Characteristics ( cont’d)
- 14. 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)
- 15. 0 20 40 60 80 100 120 140 Unknown Stage IV Stage III Stage II Stage I 6.2% .5% 67.4% 5.7% 20.2% FIGO Stage at Diagnosis
- 16. Serous Mucinous Endometrioid Clear Cell Mixed Undifferentiated 64.8% 19.2% 11.4% 2% Distribution by Histology
- 17. Distribution by Grade Grade 1 Grade 2 Grade 3 22% 41% 37%
- 18. • 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
- 19. 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
- 20. Table 3
- 21. 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).
- 22. PFS by Age
- 23. PFS by Pregnancy #
- 24. Progression free survival Parity > 10 pregnancies ( 13.4%) < 10 pregnancies ( 86.5%) 16.0 months 17.1 months p = 0.02
- 25. PFS by Stage
- 26. PFS by Residual disease
- 27. Progression free survival Residual disease Optimal debulking Suboptimal debulking 22 months 13.5 months ( p = 0.001) Statisticaly significant
- 28. PFS by Treatment
- 29. •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
- 30. Strengths: this is the first study evaluating EOC in Saudi patients. central pathologic review of all cases relatively large cohort of patients
- 31. 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).
- 32. Thank you