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. 2021 Aug;10(8):3705-3715.
doi: 10.21037/tcr-20-3233.

Long term survival of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in advanced epithelial ovarian cancer

Jue Zhang  1 , Xin-Bao Li  1 , Ru Ma  1 , Zhong-He Ji  1 , Wenpei Bai  2 , Yan Li  1
Affiliations

Long term survival of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in advanced epithelial ovarian cancer

Jue Zhang et al. Transl Cancer Res. 2021 Aug.

Abstract

Background: To compare the efficacy of conventional debulking surgery and cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with the peritoneal metastasis of epithelial ovarian cancer (EOCPC).

Methods: In patients with ovarian cancer who underwent surgery-based multidisciplinary treatment at our center from May 2004 to November 2019, 186 EOCPC patients were divided into a control group (conventional debulking surgery, n=115) and a study group (CRS+HIPEC, n=71) and were matched for baseline characteristics by propensity score matching (PSM). The endpoints were median overall survival (mOS) and median progression-free survival (mPFS).

Results: After matching, 133 patients met the selection criteria, including 80 patients in the control group and 53 patients in the study group. The mOS in the study group was significantly longer than that in the control group (87.3 vs. 25.2 months, respectively, P=0.002). For complete cytoreduction, the mPFS in the study group was significantly longer than that in the control group [(19.6 vs. 10.1 months, respectively, P=0.007)]. For complete CRS, the mOS in the study group was significantly longer than that in the control group [103.3 vs. 46.2 months, respectively, P=0.020]. For incomplete CRS, the mOS in the study group was not different between the two groups.

Conclusions: Standardized CRS+HIPEC can contribute significant survival benefits to patients with EOCPC.

Keywords: CRS+HIPEC; Epithelial ovarian cancer (EOC); peritoneal carcinomatosis (PC); propensity score matching (PSM); survival.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tcr-20-3233). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of patient selection. Of 200 patients, 14 patients with non-epithelial ovarian cancer and follow-up <1 month were excluded, and the remaining 186 patients were matched. Patients were assigned to the study and control groups according to the initial treatment after diagnosis. The two treatment strategies were compared for efficacy.
Figure 2
Figure 2
Overall survival. (A) Survival rate between the two groups; (B) median overall survival between the two groups; (C) the 1- to 5- year survival rates in the study group were 88.3%, 76.4%, 70.0%, 70.0%, and 46.7%, respectively, while they were 73.2%, 58.9%, 36.7%, 36.7%, and 18.3% in the control group, showing significant differences between the two groups.
Figure 3
Figure 3
Progression-free survival analysis. (A) There was a significant difference in the recurrence rate between the two groups (P=0.035). (B) The median PFS rates were 19.6 months (95% CI, 12.6–26.5 months) in the study group and 10.1 months (95% CI, 7.6–12.7) in the control group (P=0.007).
Figure 4
Figure 4
OS analysis in patients in the two groups who underwent complete and incomplete cytoreduction. (A) The median OS rates in the CC 0-1 and R0-1 groups. (B) The median OS rates in the CC 2-3 and RD2 groups. OS, overall survival.
See this image and copyright information in PMC

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