1) This study analyzed 193 Saudi women diagnosed with epithelial ovarian cancer between 1997-2006 to characterize patients, tumor characteristics, treatment outcomes, and survival rates. 2) The majority of patients (67.4%) presented with late stage III or IV disease. Most tumors were high grade serous carcinoma (64.8%). 3) Despite high rates of intermarriage in Saudi society, only 2.1% of patients reported a family history of cancer. Higher parity (>10 pregnancies) was associated with improved progression-free survival. 4) Optimal debulking surgery and platinum-based chemotherapy resulted in a median progression-free survival of 22 and 11.9 months respectively. Advanced stage,

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