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 ?

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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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