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  1. 1. Scientific Supervisors : Prof. Dr.B.I.Polyakov Dr.M.Y. Fedyanin Presented by: Dr.Ye Hlaing Bwar Significance of Prognostic Factors in Epithelial Ovarian Cancer M.V.LOMONOSOV MOSCOW STATE UNIVERSITY Faculty of Basic Medicine
  2. 2. Ovarian cancer is the fifth leading cause of death from cancer in women. Leading cause of death from gynecological cancer in United State .
  3. 3. Mortality from Ovarian Cancer <ul><li>The absence of a recognizable preventable cause. </li></ul><ul><li>Ovarian cancer at its early stages(I/II) is difficult to diagnose until it spreads and advances to later stages (III/IV). </li></ul><ul><li>Lack of Effective screening programme. </li></ul><ul><li>Most symptoms are non-specific and thus of little use in diagnosis. </li></ul>
  4. 4. Prognostic factor - any measurement available at the time of surgery or diagnosis that correlates with disease-free or overall survival and, as a result, is able to correlate with the natural history of the disease. (>90%) Epithelial Ovarian Cancer
  5. 5. Prognostic Factors in Epithelial Ovarian Cancer Prognostic Factors - Age - Histology - Grade - Stage(FIGO) - ECOG performance status - CA125 - Ascites - Residual disease - Ploidy - Type of chemotherapy - Interval debulking
  6. 6. <ul><li>Physical examination (including a pelvic examination) </li></ul><ul><li>Trans-vaginal ultrasound . </li></ul><ul><li>The diagnosis must be confirmed with surgery to inspect </li></ul><ul><li>the abdominal cavity. </li></ul><ul><li>Take biopsies (tissue samples for microscopic analysis) and </li></ul><ul><li>look for cancer cells in the abdominal fluid. </li></ul><ul><li>Treatment usually involves chemotherapy and surgery, and </li></ul><ul><li>sometimes radiotherapy. </li></ul><ul><li>Blood test (for CA-125 and sometimes other markers). </li></ul>Diagnosis
  7. 7. Aim of Study To indentify the statistical significance prognostic factors in epithelial ovarian cancer treated with surgery and primary systemic chemotherapy.
  8. 8. <ul><li>To indentify statistical significance of each prognostic factor. </li></ul><ul><li>To compare 5 year overall survival rate among prognostic factors. </li></ul><ul><li>To indentify statistical significance between subgroup of </li></ul><ul><li>prognostic factors. </li></ul>Objectives of study
  9. 9. Patients and Methods <ul><li>Retrospective study </li></ul><ul><li>Patients </li></ul><ul><li>- 55 patients with epithelial ovarian cancer (Blokhin Russian Cancer </li></ul><ul><li>Center, 2005-2009) </li></ul><ul><li>Treatment Programme </li></ul><ul><li>- Standard surgical procedure : Total Abdominal Hysterectomy and </li></ul><ul><li>bilateral salpingo-oophrectomy </li></ul><ul><li>- Primary systemic treatment : </li></ul><ul><li>10patients (18%) (cyclophos phamide +Cysplatin) </li></ul><ul><li>11(20%) (carboplatin+paclitaxel). </li></ul><ul><li>10(18%)(cyclophosphamide+carboplatin). </li></ul><ul><li>23(42%) carboplatin alone. </li></ul><ul><li>6(11%) Adriamycin+carboplatin. </li></ul>
  10. 10. Patients and Methods Statistical Analysis - MedCalc software (version 9.6) - x 2 test to compare distribution of baseline characteristics - Fisher’s exact test where appropriate - Kaplan-Meier method for survivals, log-rank test for comparison & Cox proportional hazard regression models for multivariate analysis Follow-up - every 3 months for 1 st two years, every 6 months for next 3 yrs & annually thereafter
  11. 11. Distribution of Patients Baseline Characteristics (n=55)
  12. 12. 5 year Overall Survival Rate (n=55)
  13. 13. Univariate Analysis of Prognostic Factors
  14. 14. Significance in Sub-group of prognostic factor
  15. 15. CONCLUSION 1. Statistical Significance of Prognostic Factors Age (P=0.028). Histology (P=0.035). FIGO stage (P=0.022). Ascites (P=0.028). <ul><li>Sub-group of prognostic factors like endometroid and clear cell </li></ul><ul><li>histology, FIGO stage II, and Ascites are significant in univariate </li></ul><ul><li>analysis. </li></ul>2. <ul><li>Age ≥70 and FIGO stage IV are considered to be as poor </li></ul><ul><li>prognostic factors (31 months). </li></ul><ul><li>Endometroid and clear cell histology have longest survival time </li></ul><ul><li>(51 months). </li></ul>3.
  16. 16. Thank You!