Lee Dowon, Lee Jinhye, Park Hyemin, Lee Yong Jae, Lee Jung-Yun, Nam Eun Ji, Kim Sang Wun, Kim Sunghoon, Kim Young Tae
Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Gland Surg. 2023 Dec 26;12(12):1696-1704. doi: 10.21037/gs-23-293. Epub 2023 Dec 22.
Secondary cytoreductive surgery (CRS) can afford promising results in patients with recurrent ovarian cancer; however, the impact of hyperthermic intraperitoneal chemotherapy (HIPEC) remains unclear. We compared the outcomes of secondary CRS combined with and without HIPEC in patients with recurrent ovarian cancer.
We retrospectively evaluated patients with recurrent ovarian cancer who underwent secondary CRS, with or without HIPEC (n=46), at the Yonsei Cancer Center between January 2006 and February 2021. Of the 46 included patients, 20 underwent secondary CRS-plus-HIPEC, while 26 underwent secondary CRS without HIPEC (henceforth referred to as secondary CRS-only).
Of the 46 patients, 84.8% and 89.1% had undergone optimal surgery and platinum-based chemotherapy, respectively, as the initial treatment before the first relapse. Overall, 32.6% of patients received maintenance therapy, such as bevacizumab or polyadenosine diphosphate ribose polymerase inhibitors. The median follow-up period was 15.9 months. The median progression-free survival (PFS) was 32.7 and 25.1 months in the secondary CRS-plus-HIPEC and secondary CRS-only groups, respectively; however, both groups failed to reach the median overall survival (OS). Based on the Kaplan-Meier analysis, there was no difference in PFS (P=0.587) or OS (P=0.239) between the two groups. We identified patients with epithelial ovarian cancer and found that the median PFS was 25.1 months in the secondary CRS-only group; this was not achieved in the secondary CRS-plus-HIPEC group (P=0.244).
In patients with recurrent ovarian cancer, secondary CRS with HIPEC did not improve survival when compared with CRS without HIPEC. However, on subgrouping patients with epithelial ovarian cancer, the addition of HIPEC to secondary CRS tended to improve PFS.
二次细胞减灭术（CRS）可使复发性卵巢癌患者获得较好的治疗效果；然而，腹腔内热灌注化疗（HIPEC）的影响仍不明确。我们比较了复发性卵巢癌患者接受和未接受HIPEC的二次CRS治疗结果。
我们回顾性评估了2006年1月至2021年2月在延世癌症中心接受二次CRS（无论是否接受HIPEC）的复发性卵巢癌患者（n = 46）。在纳入的46例患者中，20例接受了二次CRS加HIPEC，26例仅接受了二次CRS（以下简称单纯二次CRS）。
46例患者中，分别有84.8%和89.1%在首次复发前作为初始治疗接受了最佳手术和铂类化疗。总体而言，32.6%的患者接受了维持治疗，如贝伐单抗或聚腺苷二磷酸核糖聚合酶抑制剂。中位随访期为15.9个月。二次CRS加HIPEC组和单纯二次CRS组的中位无进展生存期（PFS）分别为32.7个月和25.1个月；然而，两组均未达到中位总生存期（OS）。基于Kaplan-Meier分析，两组之间的PFS（P = 0.587）或OS（P = 0.239）无差异。我们对上皮性卵巢癌患者进行了分析，发现单纯二次CRS组的中位PFS为25.1个月；二次CRS加HIPEC组未达到这一数值（P = 0.244）。
在复发性卵巢癌患者中，与未接受HIPEC的CRS相比，接受HIPEC的二次CRS并未提高生存率。然而，在上皮性卵巢癌患者亚组中，二次CRS联合HIPEC倾向于改善PFS。
