Hyperthermic intraperitoneal chemotherapy after upfront cytoreductive surgery for stage III epithelial ovarian cancer: Follow-up of long-term survival

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2025-03-04 DOI:10.1111/aogs.15094

Ziying Lei, Yue Wang, Runya Fang, Ke Wang, Jun Tian, Yangxiao Chen, Yingsi Wang, Jiali Luo, Jinfu He, Binghui Ding, Xianzi Yang, Li Wang, Shuzhong Cui, Hongsheng Tang, the Chinese Peritoneal Oncology Study group (Gynecologic Oncology Study group)

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引用次数: 0

Abstract

Introduction

The survival benefit of hyperthermic intraperitoneal chemotherapy (HIPEC) has been well defined at the time of interval cytoreductive surgery, but the role of HIPEC remains uncertain for patients with newly diagnosed advanced ovarian cancer in the upfront setting. The present study aimed to report the updated long-term survival outcomes after 5 years of follow-up from our previous multicenter retrospective cohort study to compare primary cytoreductive surgery (PCS) plus HIPEC with PCS alone among women with stage III epithelial ovarian cancer.

Material and Methods

This study was conducted at five high-volume gynecological medical centers in China from January 2010 to May 2017. Eligible patients with complete data were treated with either PCS combined with HIPEC or PCS alone. The 5-year overall survival (OS) rate was updated to compare PCS plus HIPEC with PCS alone. The inverse probability of treatment weighting (IPTW) method based on a propensity score model for each patient was used to control the confounding factors and evaluate the effect of HIPEC.

Results

Data from 789 patients, a total of 584 eligible stage III epithelial ovarian cancer patients were ultimately included in the analysis (PCS-plus-HIPEC group, n = 425; PCS-alone group, n = 159). After IPTW adjustment, the median OS was 44.5 (95% CI, 40.1–49.1) months in the PCS-plus-HIPEC group and 32.4 (95% CI, 28.8–40.3) months in the PCS-alone group (weighted hazard ratio, 0.74; 95% CI, 0.59–0.93; p = 0.006). At 5 years, the OS rates were 37.9% (95% CI, 33.0%–42.8%) in the PCS-plus-HIPEC group and 26.4% (95% CI, 18.9%–34.6%) in the PCS-alone group (p = 0.007). After stratification into optimal and suboptimal cytoreduction subgroups, patients in the PCS-plus-HIPEC group maintained a greater association with improved OS than those in the PCS-alone group. Among the women who underwent optimal cytoreduction in the PCS-plus-HIPEC group and PCS-alone group, the median OS was 49.9 (95% CI, 45.2–58.4) months and 37.8 (95% CI, 30.5–53.0) months (p = 0.042) while the 5-year OS rate was 43.7% (95% CI, 37.7%–49.6%) and 33.2% (95% CI, 23.3%–43.5%), respectively (p = 0.040). Meanwhile, for those treated with suboptimal cytoreduction subgroup in the PCS-plus-HIPEC and PCS-alone groups, the median OS was 28.4 (95% CI, 22.2–39.9) months and 20.6 (95% CI, 10.6–32.4) months (p = 0.099) while the 5-year OS rate was 22.4% (95% CI, 15.1%–30.5%) and 12.2% (95% CI, 4.4%–24.2%), respectively (p = 0.060). The median follow-up period was 87.2 (95% CI, 85.1–92.7) months.

Conclusions

The updated results indicate that the addition of HIPEC is associated with improved long-term survival outcomes beyond 5 years for patients with stage III epithelial ovarian cancer in the upfront setting.

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III期上皮性卵巢癌术前细胞减少手术后的腹腔内高温化疗：长期生存随访。

导论：在间歇细胞减少手术时，热腹腔化疗（HIPEC）的生存益处已经得到了很好的定义，但HIPEC在新诊断的晚期卵巢癌患者的前期治疗中的作用仍然不确定。本研究旨在报道我们之前的多中心回顾性队列研究的最新长期生存结果，该研究比较了原发性细胞减少手术（PCS）加HIPEC与单纯PCS在III期上皮性卵巢癌患者中的随访。材料与方法：本研究于2010年1月至2017年5月在中国五家大容量妇科医疗中心进行。数据完整的符合条件的患者接受PCS联合HIPEC或PCS单独治疗。更新5年总生存率（OS），比较PCS + HIPEC与单独PCS。采用基于倾向性评分模型的治疗加权逆概率法（inverse probability of treatment weighting， IPTW）控制混杂因素，评价HIPEC的效果。结果：789例患者的数据，总共584例符合条件的III期上皮性卵巢癌患者最终被纳入分析(pcs + hipec组，n = 425；单独使用pcs组，n = 159)。经IPTW调整后，pcs + hipec组的中位OS为44.5 （95% CI, 40.1-49.1）个月，单独pcs组的中位OS为32.4 （95% CI, 28.8-40.3）个月(加权风险比，0.74；95% ci, 0.59-0.93；p = 0.006)。5年时，pcs + hipec组的OS率为37.9% (95% CI, 33.0%-42.8%)，单独pcs组的OS率为26.4% (95% CI, 18.9%-34.6%) （p = 0.007）。在分为最佳和次最佳细胞减少亚组后，与单独使用pcs组相比，pcs + hipec组患者与OS改善的相关性更大。在细胞减少最佳的pcs + hipec组和单独pcs组中，中位OS分别为49.9 （95% CI, 45.2-58.4）个月和37.8 （95% CI, 30.5-53.0）个月（p = 0.042），而5年OS率分别为43.7% （95% CI, 37.7%-49.6%）和33.2% (95% CI, 23.3%-43.5%) （p = 0.040）。与此同时，在pcs + hipec组和单独pcs组中，次优细胞减少亚组的中位OS为28.4 （95% CI, 22.2-39.9）个月和20.6 （95% CI, 10.6-32.4）个月（p = 0.099），而5年OS率分别为22.4% （95% CI, 15.1%-30.5%）和12.2% (95% CI, 4.4%-24.2%) （p = 0.060）。中位随访时间为87.2个月（95% CI, 85.1-92.7）。结论：最新的研究结果表明，HIPEC的加入与III期上皮性卵巢癌患者5年以上的长期生存预后改善有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.