Epidemiological and clinicopathological characteristics of ovarian cancer in Syria during the war years: a national multicenter retrospective study (2017–2021)

Despite the high burden and regional variability of ovarian cancer (OC), data on its status in Syria, a country impacted by long-standing conflict, remain scarce. This study aimed to provide the first nationwide analysis of OC epidemiological and clinicopathological characteristics. In this national, multicenter, retrospective cross-sectional study, we collected data from three tertiary referral university hospitals in Syria: Tishreen University Hospital, Al-Bairouni University Hospital, and Ibn Rushd Hospital. The inclusion period spanned from 2017 to 2021. All included patients were 18 years or older and had a newly diagnosed, confirmed primary OC. Data collected included sociodemographic information, presenting symptoms, CA-125 levels, and treatment details. A total of 531 patients with OC with a mean age of 53.1 years (range: 18–91) were included in the study, representing 1.2% (95% confidence interval: 1.1%-1.3%) of the 44,248 patients diagnosed with all types of cancer. Serous carcinoma (55.4%) was the most common OC subtype, followed by mucinous (13.8%) and endometrioid carcinoma (9.7%). Among epithelial OCs, having high levels of CA-125 was associated with higher odds of serous carcinoma (adjusted OR: 2.30, 95% CI: 1.08–4.91) and lower odds of endometrioid cancer adjusted OR: 0.21, 95% CI: 0.08–0.54). Abdominal bloating was the most frequently reported symptom, affecting 194 patients (36.5%). Our study revealed a lower proportion of OCs diagnoses among all cancer cases compared to global and regional data which may be attributed to underreporting, influenced by the disease's specific characteristics and presence of more barriers for women to healthcare access in Syria's conflict-affected setting. Given the study's limitations, further research is essential to provide a more comprehensive assessment of the OC burden in Syria.