Taliento C, Restaino S, Arcieri M, Scutiero G, Greco P, Scambia G, Vizzielli G
Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy.
Clinic of Obstetrics and Gynecology, "Santa Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
Ann Surg Oncol. 2025 May;32(5):3648-3659. doi: 10.1245/s10434-025-16979-6. Epub 2025 Feb 4.
In 2024, two randomized controlled trials (RCTs) were published, providing new high-quality evidence on HIPEC in epithelial ovarian cancer (EOC). Updating data on progression-free survival (PFS) and adverse events could offer a clearer understanding of the benefits and risks of HIPEC combined with cytoreductive surgery (CRS), with or without prior neoadjuvant chemotherapy (NACT).
An electronic search was conducted using PubMed, Web of Science, EBSCO, and CENTRAL up to 23 November 2024. We only included RCTs reporting PFS and adverse events of interval or secondary CRS, with or without HIPEC, in newly diagnosed or recurrent EOC.
The meta-analysis included six RCTs. The addition of HIPEC to surgery significantly improved PFS in patients with newly diagnosed advanced-stage EOC who received NACT (HR 0.59; 95% CI 0.39-0.88; p = 0.01). No significant difference in PFS was observed between secondary CRS plus HIPEC and CRS alone in recurrent ovarian cancer without prior NACT (HR 1.22; 95% CI 0.82-1.83; p = 0.32). Regarding adverse events, a decrease in platelet count of any grade was more frequent in the HIPEC group (p = 0.03). The overall risk of acute kidney failure (AKF) was 10.6%, with a significantly higher incidence compared with CRS alone (p = 0.003).
The addition of HIPEC to CRS significantly improved PFS compared with surgery alone in patients with advanced EOC who received NACT. However, the treatment was associated with a higher incidence of AKF, which occurred in 10.6% of patients who underwent HIPEC.
2024年，两项随机对照试验（RCT）发表，为上皮性卵巢癌（EOC）的腹腔热灌注化疗（HIPEC）提供了新的高质量证据。更新无进展生存期（PFS）和不良事件的数据可以更清楚地了解HIPEC联合细胞减灭术（CRS）（无论是否接受过新辅助化疗（NACT））的益处和风险。
截至2024年11月23日，使用PubMed、科学网、EBSCO和CENTRAL进行电子检索。我们仅纳入了报告新诊断或复发性EOC患者接受间隔或二次CRS（无论是否进行HIPEC）的PFS和不良事件的RCT。
荟萃分析纳入了六项RCT。在接受NACT的新诊断晚期EOC患者中，手术联合HIPEC显著改善了PFS（风险比[HR]0.59；95%置信区间[CI]0.39 - 0.88；p = 0.01）。在未接受过NACT的复发性卵巢癌患者中，二次CRS联合HIPEC与单纯CRS相比，PFS无显著差异（HR 1.22；95% CI 0.82 - 1.83；p = 0.32）。关于不良事件，HIPEC组任何级别的血小板计数下降更为常见（p = 0.03）。急性肾衰竭（AKF）的总体风险为10.6%，与单纯CRS相比，发生率显著更高（p = 0.003）。
在接受NACT的晚期EOC患者中，与单纯手术相比，CRS联合HIPEC显著改善了PFS。然而，该治疗与较高的AKF发生率相关，在接受HIPEC的患者中，AKF发生率为10.6%。
