Achieving Complete Radiological and Bio-Chemical Response as a Predictor of Long-Term Survival in Stage IV Epithelial Ovarian Cancer.

Hafiz Abubakar Sarwar,Musa Azhar,Muhammad Rashid Hanif,Neelam Siddiqui,Jhanzeb Iftikhar,Muhammad Abu Bakar,Kiran Munawar

doi:10.7759/cureus.20017

Abstract

ObjectiveEpithelial ovarian cancer (EOC) is common among ovarian cancers. The majority of existing literature shows combined data of stage III and stage IV. Therefore, we aimed to look for whether achieving complete radiological and biochemical response after initial treatment of stage IV epithelial ovarian cancer as a predictor of long-term survival in the Pakistani population.MethodsA cross-sectional study was conducted of patients with stage IV epithelial ovarian cancer diagnosed and treated from 2006-2013 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Overall survival was defined as the number of months between patients’ diagnosis at the hospital and any cause of death or last follow-up date. Kaplan Meier curve was used to report the overall survival. The log-rank test was used to distinguish the survival difference in complete and no complete response. P-value <0.05 was considered statistically significant.ResultA total of fifty patients of stage IV epithelial ovarian carcinoma, with a mean age of 53 ± 2 received neoadjuvant chemotherapy and suitable patients underwent interval-debulking surgery. Among these fifty patients, twenty-one (42%) patients who achieved complete radiological and biochemical response had a median survival of greater than five years. Patients without co-morbidities (46%) and having good performance status (52%) showed better results of the treatment. Patients’ tolerance to chemotherapy with good response and fit enough to undergo interval-debulking surgery, achieving complete radiological and biochemical response after initial induction therapy were significantly associated with long-term survival (P<0.05).ConclusionOutcomes of patients who present with stage IV EOC remains dismal. Patients who achieved complete radiological and biochemical response after neoadjuvant chemotherapy and interval-debulking surgery was significantly associated with long-term survival.

Highlights

Ovarian cancer is the fifth leading cause of cancer-related death and accounts for 3% of all cancers among women worldwide [1]
Eight percent (8%) of patients had an ECOG (Eastern Cooperative Oncology Group) performance status of 0
Epithelial Ovarian Cancers (EOC) accounts from 63.5% to 83.3% in various studies conducted in Pakistan [11]

Summary

Introduction

Ovarian cancer is the fifth leading cause of cancer-related death and accounts for 3% of all cancers among women worldwide [1]. Ninety percent of malignant tumours of the ovary are Epithelial Ovarian Cancers (EOC). EOC is further classified into Type I and Type II tumours [2,3] Low-grade tumours are type I tumours and carry mutations of BRAF, KRAS, and PTEN. These tumour types include endometrioid, mucinous, and clear cell histologies. While type II tumours include high-grade serous, high-grade endometrioid, malignant mixed mesodermal tumors, and undifferentiated carcinomas. These tumour types harbour BRCA1, BRCA2 and p53 mutations [4]

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