Clinicopathologic characteristics and treatment outcomes of advanced high-grade serous ovarian cancer in Pakistan: A single-center study.

Abstract

e17553 Background: High-grade serous ovarian carcinoma (HGSC) is the most lethal subtype of ovarian cancer. Evidence from low- and middle-income countries remains limited, particularly regarding access to genetic testing and delivery of multimodality care. The purpose of this study was to describe real-world patterns of presentation, treatment, and outcomes of advanced HGSC in a resource-limited setting and to identify gaps relevant to future care improvement. Methods: We conducted a retrospective review of 50 patients with FIGO stage III–IV HGSC treated between 2024 and 2025 at a tertiary care center in Pakistan. Collected variables included age, family history, BRCA1/2 testing status, disease stage, use of neoadjuvant chemotherapy (NACT), surgical intervention, systemic chemotherapy, and documented treatment response. Results: Median age was 50 years (range, 31–65), with 20% of patients aged ≤40 years. Stage III disease was observed in 36% and stage IV in 64%. A positive family history was present in 18%. BRCA testing was performed in only 16%, with pathogenic variants identified in 37.5% of those tested. NACT was administered in 40%, surgery in 70%, and systemic chemotherapy in 84% of patients. Surgical intervention was more frequent in stage III compared with stage IV disease (83% vs 63%), reflecting differences in disease burden at presentation. Among patients with available outcome data, complete response was predominantly observed in stage III disease treated with combined surgery and chemotherapy. Conclusions: Patients frequently presented at a younger age and with advanced-stage HGSC, underscoring delays in diagnosis and referral. Despite resource constraints, meaningful clinical responses were achievable with comprehensive multimodality treatment, particularly in stage III disease. These findings support prioritization of expanded BRCA testing, multidisciplinary treatment pathways, and prospective data collection. Strengthening early detection, genetic risk stratification, and health system capacity may reduce global disparities and improve ovarian cancer outcomes in low-resource settings. Patient characteristics and treatment summary (N = 50). Variable Value Median age, years (range) 50 (31–65) Age ≤40 years 10 (20%) Stage III disease 18 (36%) Stage IV disease 32 (64%) Positive family history 9 (18%) BRCA testing performed 8 (16%) BRCA-positive (of tested) 3 (37.5%) Neoadjuvant chemotherapy 20 (40%) Surgery performed 35 (70%) Systemic chemotherapy 42 (84%)