Kohut Adrian, Anderson Matthew L, Andikyan Vaagn, Yasukawa Maya, Nguy Lindsey, Karachristos Andreas, Nywening Timothy, Mor Gil, Gogoi Radhika, Cohen Joshua G, Lin Jeff F, Rutherford Thomas J
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
Tampa General Hospital, Tampa General Hospital Cancer Institute, Tampa, FL, USA.
Ann Surg Oncol. 2025 Jun;32(6):4326-4334. doi: 10.1245/s10434-025-17269-x. Epub 2025 Apr 6.
Hyperthermic intraperitoneal chemotherapy (HIPEC) is used to eliminate minimal residual disease in patients with peritoneal surface malignancies, including advanced epithelial ovarian cancer (EOC). While some trials suggest potential benefits, the role of HIPEC during cytoreductive surgery (CRS) in EOC remains uncertain. This study aimed to evaluate outcomes for patients undergoing HIPEC during CRS for advanced-stage EOC in the United States (US).
This multicenter, retrospective cohort study included women with stage III-IV EOC who underwent CRS with or without HIPEC between 2006 and 2021 at Commission on Cancer-accredited US facilities. Propensity score matching was used to create a control group of patients who underwent CRS only. Overall survival (OS) was analyzed using the Kaplan-Meier log-rank method and adjusted for confounding factors with Cox proportional hazards regression.
Among 1400 patients identified, 700 underwent CRS with HIPEC and 700 underwent CRS only. Of these 1400 patients, 932 underwent interval CRS and 468 underwent primary CRS. No significant difference in median OS was observed between the overall CRS+HIPEC and CRS-only groups (57.6 vs. 47.6 months; p = 0.105). However, interval CRS+HIPEC was associated with significantly improved median OS compared with interval CRS-only (57.6 vs. 45.7 months; p = 0.003). After adjustment, HIPEC remained significantly associated with improved survival (hazard ratio 0.77, 95% confidence interval 0.64-0.92; p = 0.004).
HIPEC is associated with improved OS in patients undergoing interval CRS for advanced-stage EOC. Further research should explore the selective use of HIPEC during interval CRS.
热灌注腹腔化疗（HIPEC）用于清除腹膜表面恶性肿瘤患者的微小残留病灶，包括晚期上皮性卵巢癌（EOC）。虽然一些试验表明了潜在益处，但HIPEC在EOC细胞减灭术（CRS）中的作用仍不确定。本研究旨在评估美国晚期EOC患者在CRS期间接受HIPEC的疗效。
这项多中心回顾性队列研究纳入了2006年至2021年期间在美国癌症委员会认可的机构接受CRS（伴或不伴HIPEC）的III-IV期EOC女性患者。采用倾向评分匹配法创建仅接受CRS的对照组。使用Kaplan-Meier对数秩检验分析总生存期（OS），并通过Cox比例风险回归对混杂因素进行校正。
在确定的1400例患者中，700例接受了CRS联合HIPEC，700例仅接受了CRS。在这1400例患者中，932例接受了间隔期CRS，468例接受了初次CRS。CRS联合HIPEC组与单纯CRS组的中位OS无显著差异（57.6个月对47.6个月；p = 0.105）。然而，与单纯间隔期CRS相比，间隔期CRS联合HIPEC的中位OS显著改善（57.6个月对45.7个月；p = 0.003）。校正后，HIPEC仍与生存率改善显著相关（风险比0.77，95%置信区间0.64-0.92；p = 0.004）。
对于晚期EOC患者，在间隔期CRS期间接受HIPEC与OS改善相关。进一步的研究应探索在间隔期CRS期间选择性使用HIPEC。
