Management of epithelial ovarian cancer at a tertiary centre in South Africa: a retrospective evaluation of early recurrence and contributory factors
Thesis (MPhil)--Stellenbosch University, 2019.
Introduction. Epithelial ovarian cancer is associated with high recurrence rates and poor survival, especially if the disease is advanced, surgery sub-optimal, and or has high-grade histology. However, there is a paucity of information regarding recurrence and survival in epithelial ovarian cancer in Africa. We aimed to assess early recurrence rate, associated factors, and patterns of recurrence of epithelial ovarian cancer, at a tertiary centre in South Africa. Materials and Methods. A retrospective review of records of patients with epithelial ovarian cancer managed in a single institution over a nine-year period was performed with relevant ethics approval (S18/04/078). Case records were searched and information about age, parity, baseline serum CA125, histologic sub-type and grade, FIGO stage, neoadjuvant and adjuvant chemotherapy status and number of cycles, optimality of staging/debulking surgery, the month adjuvant treatment was completed, and month of recurrence were abstracted. Exclusion criteria included documented primary peritoneal cancer, platinum-resistant patients, and those with inadequate follow-up information. IBM SPSS version 25® was used for statistical analysis. Descriptive statistics which included percentages, means and medians, were used to assess recurrence. Fisher’s exact and χ² tests were used to assess for factors with significant association to early recurrence. p-value<0.05 was considered statistically significant. Results. A total of 124 patients definitively treated for epithelial ovarian cancer with adequate records were identified. Final analysis was performed for 91 patients after 33 were excluded. Early-stage disease comprised 47% of the cases. Nearly 50% of patients had papillary serous histology. Optimal cytoreduction was achieved in 70% of cases. Recurrence rate ≤ 24 months was 33% with a median time to recurrence of 14 months (IQR 8.75-20.75) for stages I and II disease, and 67% with a median time to recurrence of 12 months (IQR 8-14.25) for stages III and IV disease. Isolated pelvic recurrence was diagnosed in 50% of early- stage disease but, a trend towards multiple distant-site recurrence was observed in FIGO stage III/IV disease. Tumour histology was the only significant factor associated with early recurrence (p=0.005). Cytoreduction status, use of neoadjuvant chemotherapy, baseline CA125, parity, and patient age did not demonstrate association with early recurrence. Conclusions. Early recurrence of epithelial ovarian cancer in this patient population appears higher compared to published literature. However, a standardized surgical protocol, objective intra-operative assessment of residual tumour, and adequate surgical record are essential for an in-depth study of surgical factors in ovarian cancer recurrence for our setting.
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