Survival outcomes following interval versus primary debulking surgery in advanced epithelial ovarian cancer: A retrospective cohort study in Lagos, Southwest Nigeria.

Background: There is conflicting evidence regarding the survival benefit of interval debulking surgery (IDS) compared to conventional treatment with primary debulking surgery (PDS) in women with advanced epithelial ovarian cancer (EOC). Objectives: We compared the survivals following PDS followed by adjuvant chemotherapy (ACT) versus IDS after neoadjuvant chemotherapy (NACT) in women with advanced EOC at the gynaecological oncology unit of a tertiary referral centre in Lagos, Southwest Nigeria. Methods: The data of 126 women with advanced EOC who had standard treatment with either PDS and ACT or NACT and IDS between January 2008 and December 2017 were analyzed. Kaplan-Meier estimates of progression-free (PFS) and overall survival (OS) time stratified by the types of upfront debulking surgery were calculated and compared by employing the log-rank test statistics. Cox proportional hazard models were then used to estimate hazard ratios of the association between the type of surgical debulking and survivals while adjusting for all necessary covariates. Results: We recorded no statistically significant differences in PFS (adjusted hazard ratio=1.28, 95% confidence interval 0.82-2.01, P=0.282) and OS (adjusted hazard ratio=1.23, 95% confidence interval 0.68-2.25, P=0.491) between IDS and PDS among women with advanced EOC. Conclusions: There is a need for a larger prospective multicenter study to further compare the impact of upfront surgical debulking types on the survival of women with advanced EOC in our setting. In the meantime, giving interval debulking surgery after a few courses of neoadjuvant chemotherapy should be an acceptable standard of care for women with advanced EOC.

Prognostic performance of pretreatment systemic immune-inflammation index in women with epithelial ovarian cancer.

Purpose: This study investigated the prognostic performance of the systemic immune-inflammation index (SII) in patients with epithelial ovarian cancer (EOC) in Lagos, Nigeria. Methods: We performed a secondary analysis of the data of 91 women who had treatment for EOC between 2009 and 2018. The associations between pretreatment SII and survivals were tested. Results: Pretreatment SII more than 610.2 was a significant independent predictor of reduced progression-free survival (HR = 2.68; 95% CI, 1.17 to 6.09) while SII greater than 649.0 was a significant independent predictor of reduced 3-year overall survival (HR = 2.01; 95% CI, 1.01 to 3.99). Conclusion: These findings suggest that high SII may be a potential prognostic indicator and useful marker for more intensive surveillance and design of personalized treatment in patients with EOC.

This study looked at how the systemic immune-inflammation index (SII) can predict the outcomes of patients with epithelial ovarian cancer (EOC). To do this, the data of 91 women who received treatment for EOC between 2009 and 2018 were analyzed. The study concluded that when the SII level was higher than 610.2 and 649.0, it was linked to a higher likelihood of EOC progressing sooner and of reduced survival at the 3-year mark, respectively. This suggests that a high SII might be a useful predictor to understand how EOC could progress and how well patients with EOC might survive.

Pattern and predictors of cervical epithelial cell abnormalities among unscreened and under-screened women in Lagos, Nigeria: a cross-sectional study.

Women who had never undergone cervical screening (CS) or who have infrequent CS are at increased risk of having cervical epithelial cell abnormalities (CECA) that may lead to cervical cancer (CCa). Our study determined the pattern and factors that predict the occurrence of CECA among unscreened and under-screened women in Lagos, Nigeria. This was an analytical cross-sectional study among 256 consenting sexually active women between 21 and 65 years who attended a community CS programme in Surulere, Lagos, Nigeria, in June 2019. Information on socio-demographic, reproductive, sexual, behavioural and clinical characteristics were collected and a Pap smear test was done. Women with abnormal cervical cytology were followed up and given appropriate treatment. Data analysis was done using Statistical Package for Social Sciences version 23. Descriptive statistics were computed using frequencies and association was tested using odd ratio. The participants' mean age was 42.7 ± 10.3 years, majority were married (79.9%) and were human immune deficiency syndrome (HIV) negative (63.1%). The prevalence of CECA was 9.8%. Atypical squamous cell of undetermined significance and atypical squamous cell cannot exclude high-grade squamous intraepithelial lesion were the most common CECA with prevalence rates of 7.4% and 2.0%, respectively. Having a partner with multiple sexual partners (adjusted odd ratio (AOR) = 19.23), being HIV positive (AOR = 25.61), giving birth for the first time before the age of 26 years (AOR = 5.55) and presence of a combination of either abnormal vaginal discharge, contact bleeding or an unhealthy cervix on clinical examination (AOR = 13.65) independently predicted the occurrence of CECA. There is a need to prioritise CS for women with these risk factors to prevent CCa and reduce the burden of the disease in our environment.

Predictors of Pap smear testing uptake among women in Lagos, Nigeria.

We assessed the predictors of Pap smear testing uptake within 6 months after cervical cancer prevention education among women in Lagos, Nigeria. This was a prospective follow-up study conducted as part of the 'mHealth-Cervix trial' in the two teaching hospitals in Lagos, Nigeria, between August 2020 and April 2021. Participants were followed up for 6 months after pre-enrolment cervical cancer prevention education. The potential socio-demographic and clinical predictors of Pap smear testing uptake during the 6-month follow-up were tested using the predictive model in a binary logistic regression analysis. Statistical significance was reported as p < 0.05. The rate of Pap smear testing uptake during the 6-month follow-up was 35.7%. Following the adjustments in the final multivariate analysis, participants' previous awareness of Pap smearing (RR = 6.92, 95% CI: 8.37-56.68, p = 0.001) and attendance at the general outpatient clinic during the period of follow-up (RR = 11.22, 95% CI: 1.54-81.51, p = 0.017) independently predict Pap smear testing uptake. We will, therefore, explore the impact of continuous provision of health promotion on cervical cancer prevention and its effect in the context of routine clinical care in our next implementation research agenda. We recommend, in the meantime, that regular health education of women on cervical cancer prevention by healthcare providers should be further reinforced as an integral part of health promotion in clinics to reduce the burden of cervical cancer in most low- and middle-income settings.

Predictors of early mortality risk in patients with epithelial ovarian cancer.

Background: To improve the overall survival of epithelial ovarian cancer (EOC) patients, a more precise risk identification after completion of standard treatment will enhance patients' follow-up surveillance and the use of individualized targeted therapy. Aim: This study explored the potential risk predictors of early mortality in EOC patients who had standard treatment with debulking surgery and chemotherapy. Methods: The study included 93 EOC patients who had standard treatment and were followed up between January 2011 and December 2020. The sociodemographic, clinical, and laboratory data of patients with EOC including the update on their 3-year follow-up status were retrospectively collected and analyzed. Early mortality is defined as the death of a patient within 3 years of completion of standard treatment. Patients' data were computed using descriptive statistics and the associations between patients' factors and the risk of early mortality were tested using the binary logistic regression model. Results: Early deaths occurred in 36 (38.7%) of patients with EOC. In the final multivariate analyses, early tumor relapse within 6-months of treatment completion was the only independent risk factor that predicts early mortality in EOC patients (risk ratio = 8.6, 95% confidence interval: 3.3-24.5, p < 0.01). Conclusion: Our study suggests that early tumor relapse may be a useful surrogate of early mortality in EOC. However, our findings should be interpreted with caution pending further corroboration through an adequately powered, prospective multicenter study.

Preoperative Predictors of Optimal Tumor Resectability in Patients With Epithelial Ovarian Cancer.

Background Several studies have shown that whether complete tumor resection can be achieved during debulking surgery depends on various patient-related factors. However, none of these studies was conducted among patients with epithelial ovarian cancer (EOC) in sub-Saharan Africa. In this study, we aimed to determine the preoperative predictors of optimal tumor resectability (OTR) during primary debulking surgery (PDS) in patients with EOC. Methodology In this study, we reviewed all patients with histologically diagnosed EOC who underwent PDS between January 2011 and December 2020. We included 83 patients with complete clinical records for subsequent data analysis. Descriptive statistics were computed for patients' data, and binary logistic regression analysis was used to assess the strength of associations between patients' preoperative characteristics and OTR. Results The overall rate of OTR was 53.0%, while the rate in advanced EOC patients was 36.1%. In the univariate analyses, pleural effusion, ascites, tumor bilaterality, size of the largest tumor, retroperitoneal lymph nodes, omental caking, peritoneal thickening, significant extrapelvic tumor, serum cancer antigen-125 (CA-125) levels, and hemoglobin levels were recorded as the predictors of OTR. However, after adjusting for covariates in the final multivariate models, we found that the absence of moderate-to-large pleural effusion (odds ratio (OR) = 5.60; 95% confidence interval (CI) = 1.32, 23.71) and having serum CA-125 levels of ≤370 U/mL (OR = 6.80; 95% CI = 1.19, 38.79) were the overall independent predictors of OTR while not having any preexisting comorbidity (OR = 18.21; 95% CI = 2.40, 38.10), and the absence of pleural effusions (OR = 13.75; 95% CI = 1.80, 24.85) or enlarged retroperitoneal lymph nodes (OR = 11.95; 95% CI = 1.35, 16.07) were predictors of OTR in advanced EOC patients. Conclusions We demonstrated that the radiological absence of pleural effusions and enlarged retroperitoneal lymph nodes and having no preexisting medical morbidity and serum CA-125 levels of ≤370 U/mL were the independent predictors of OTR during PDS. The preliminary data generated from this study can be used to develop variables for a prediction model in a future validation study.

Pretreatment Neutrophil-to-Lymphocyte Ratio: A Prognostic Biomarker of Survival in Patients With Epithelial Ovarian Cancer.

Background Inflammation is pathognomonic of all stages of tumor formation, and therefore, there is renewed interest in systemic inflammatory response (SIR) markers including haematological inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) as prognostic predictors in several cancers. Aim This study was aimed to investigate the effect of pretreatment peripheral blood NLR on the survival prognosis of patients with epithelial ovarian cancer (EOC). Methods We identified 93 patients with a complete clinical record from a cohort of 155 patients who received treatment for EOC between 2009 and 2018. Patients' sociodemographic and clinicopathologic characteristics, and updated three-year follow-up status were extracted from medical records. Pretreatment peripheral blood NLR was calculated by dividing the neutrophil count by the lymphocyte count. We employed the receiver operating characteristic (ROC) curve to identify the optimal cut-off value of the NLR in estimating progression-free survival (PFS) and overall survival (OS). The PFS and OS were assessed using the Kaplan-Meier method, and survival differences were compared using the Log Rank (Mantel-Cox) test. Independent prognostic predictors were determined using Cox regression analysis. Results According to the ROC curves, the optimal cut-off values for the NLR were 2.23 and 1.93 for PFS and OS, respectively. A high NLR was associated with poor PFS (P = 0.033) and OS (P = 0.013) in the univariate analyses. In the multivariate analyses, a high NLR was still an independent predictor of OS (hazard ratio [HR] = 2.23; 95% CI, 1.08 to 4.61) but not PFS (hazard ratio [HR] = 2.43; 95% CI, 0.95 to 6.27). Conclusion The NLR at an optimum cut-off value of 1.93 is an independent prognostic predictor of OS in patients with EOC.

Predictors, barriers and motivating factors for human papillomavirus vaccination and testing as preventive measures for cervical cancer: A study of urban women in Lagos, Nigeria.

Human papillomavirus (HPV) vaccination and HPV based cervical screening are scientifically proven ways to prevent and eliminate cervical cancer (CC). Unfortunately, these measures are yet to be widely accepted or utilized. Our study aimed to explore the individual-related factors that predict HPV vaccination and testing, its motivating factors and barriers among urban women in Lagos, Nigeria. This was a descriptive cross-sectional study among 208 consenting women who attended a community health awareness program in Surulere, Lagos, Nigeria, in September 2019. Structured questionnaires were interviewer administered and analysis was done using SPSS version 23. The uptake of HPV vaccination and testing was 29.0% and 3.0% respectively. Being employed [adjusted odds ratio (AOR) = 60.45, CI = 10.64-343.46, P < 0.001] and unmarried (AOR = 33.33, CI = 12.5-100.0, P < 0.001) predicted HPV vaccination uptake while being unmarried was the only predictor of uptake of HPV testing [crude odds ratio (COR) = 7.69, CI = 1.01-100.00, P = 0.039]. Knowing someone with CC (AOR = 21.64, CI = 4.87-96.16, P < 0.001) and being unmarried (AOR = 5.56, CI = 1.45-20.00, P = 0.012) predicted increased willingness to be vaccinated. Being unmarried (AOR = 5.26, CI = 1.89-14.29, P = 0.002) and knowing someone with CC (AOR = 6.41, CI = 2.68-15.33, P < 0.001) predicted willingness to do HPV testing. Recommendation by healthcare provider (HCP), friends/relatives and media were major motivators for HPV vaccination & testing while fear, cost, no recommendation by HCP, inaccessibility & lack of awareness were major barriers. There is need to urgently address these identified factors that affect HPV vaccination and testing in order to improve its acceptability and uptake rate in our environment.

Predictors of Survival Outcomes After Primary Treatment of Epithelial Ovarian Cancer in Lagos, Nigeria.

PURPOSE: This study was designed to investigate the clinicopathologic predictors of progression-free survival (PFS) and overall survival (OS) in patients with epithelial ovarian cancer (EOC) following primary treatment in Lagos, Nigeria. MATERIALS AND METHODS: Using data from a retrospective cohort of 126 patients who received treatment for EOC between 2010 and 2018, we identified 83 patients with a complete clinical record for subsequent data analysis. Patients' demographics and updated 2-year follow-up status were abstracted from medical records. Kaplan-Meier survival curves were compared using the log-rank test, and Cox proportional hazard models were used for multivariate analysis to identify independent predictors of survivals following treatment in EOC patients. RESULTS: The median PFS and OS were 12 and 24 months, respectively. After adjusting for covariates in the multivariate analysis, younger age ≤ 55 years (hazard ratio [HR] = 0.40; 95% CI, 0.22 to 0.74; P = .01) and International Federation of Gynecology and Obstetrics (FIGO) stage I/II (HR = 0.02; 95% CI, 0.01 to 0.08; P = .01) were independent predictors of improved PFS, whereas being premenopausal (HR = 2.34; 95% CI, 1.16 to 4.75; P = .02) was an independent predictor of reduced OS after 2-year follow-up. CONCLUSION: PFS could be predicted by the age and FIGO stage of the disease, whereas menopausal status was predictive of OS in patients with EOC. This knowledge should form the basis for counseling patients with ovarian cancer during their primary treatment and lend support to the importance of aggressive follow-up and monitoring for the older, premenopausal patients and those with an advanced stage of epithelial ovarian cancer. However, robust longitudinal research should be carried out to provide additional reliable insight to this information.