Abstract:
AbSTRACT
Introduction: Ovarian cancer is the third most frequent cause of death amongst gynecological cancers both
locally and globally. It presents with vague nonspecific symptoms and is histologically heterogeneous. Ovarian
cancer management is primarily surgical followed by adjuvant chemotherapy depending on the histological
type and the surgical stage.
Objectives: To determine the clinical-pathological presentation, treatment and outcomes of ovarian cancer
patients at Moi Teaching and Referral Hospital (MTRH), Eldoret.
Methods: This was a retrospective chart review of ovarian cancer patients managed between January 2010
and August 2017 at MTRH. Data were analyzed using STATA version 15. Survival trends were generated
using Kaplan Meier method.
Results: A total of 124 medical charts of patients with ovarian cancer were retrieved, 29 had incomplete data
and were excluded, and 95 were evaluable and included in this review. Over half, (63%) presented in stage
3 and 4 though there was no significant association between histology and stage of disease [X2(6) =4.72,
p=0.58]. The median age at diagnosis was 47 years with 55-80 years being the modal age group (36%).
Majority (57%) were married and 83.9% were unemployed. Only 66% had documented histopathology, with
Epithelial Ovarian Cancer (EOC) being most common (70%), [serous (50%) and mucinous (11.4%)]. Sex cord
stromal tumors 11%. Germ cell tumors amounted to 11% (dygerminomas 50%and Yolk sac tumors (25%)
Bivariate analysis revealed significant association only between histology and parity [X2 (6) = 28.8, p<0.001].
Those reviewed contributed a total of 138.2 person-years to the study and 11(12%) died, giving a disease-
specific mortality rate of 79.6 per 1,000 person years (95% CI: 44.1-143.8). Mortality was highest among those
with epithelial histology 109 (95% CI: 48.8-241.9) per 1,000 person years and those who had neoadjuvant
chemotherapy then surgery as a treatment option, 373.1 (95% CI: 93.3-1491.8) per 1,000 person years. Those
who underwent upfront surgery followed by adjuvant chemotherapy and sex cord stromal cancer had higher
survival probability.
Conclusion: Ovarian cancer at MTRH is diagnosed at advanced stages III and IV of disease and has a lower
median age at presentation. EOC is the commonest histological type and serous subtype is the most lethal.
Mortality was highest among those with EOC and those who underwent neoadjuvant chemotherapy. Granulosa
cell tumor is the only sex cord stromal type reported in our setting and it exhibited a higher survival probability.
Germ cell tumors were mainly found in nulliparous women.