Abstract
PurposeThe aim of this study was to help with the process of selecting patients with advanced ovarian cancer to undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) by analyzing outcome data at distinct clinical time points reflecting the natural history of the disease.MethodsIn a retrospective Italian multicenter study investigating patients with advanced ovarian cancer who underwent CRS plus HIPEC between 1998 and 2014, we analyzed data for consecutive patients at eight treatment time points: primary debulking surgery (PDS); interval debulking surgery after partial response, after no response, and after a pathologic complete response to neoadjuvant chemotherapy; first recurrence with a progression-free interval >12, <12 months, or >12 months in patients who underwent further chemotherapy before CRS and HIPEC; and patients who underwent two or more CRS procedures and chemotherapy lines before CRS and HIPEC.ResultsThe 511 enrolled patients underwent 3373 procedures; 72.6% achieved complete cytoreduction, with an overall major morbidity of 17.4%. At a median follow-up of 53.8 months, overall survival (OS) was 54.2 months (95% confidence interval [CI] 44–58.4) and progression-free (PFS) survival was 16.6 months (95% CI 14.7–19.1). Outcome analysis in patients in whom CRS plus HIPEC was used for primary advanced cancer or recurrent ovarian cancer showed significant differences in OS and PFS according to the time points analyzed. Multivariate analysis identified completeness of CRS, Peritoneal Cancer Index, and the times when patients underwent CRS plus HIPEC as independent prognostic factors.ConclusionsThis selective information on survival should help in interpreting the findings from ongoing randomized studies focusing on CRS plus HIPEC in patients with advanced ovarian cancer.
Highlights
At a median follow-up of 53.8 months, overall survival (OS) was 54.2 months (95% confidence interval [confidence intervals (CI)] 44–58.4) and progression-free (PFS) survival was 16.6 months
Outcome analysis in patients in whom cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) was used for primary advanced cancer or recurrent ovarian cancer showed significant differences in OS and progression-free survival (PFS) according to the time points analyzed
We only collected data for patients whose records included complete information on clinical and epidemiological characteristics, including age, Eastern Cooperative Oncology Group (ECOG) performance status, tumor markers, diagnostic techniques, International Federation of Gynecology and Obstetrics (FIGO) stage,[24] tumor histology,[25] peritoneal disease spread according to the Peritoneal Cancer Index (PCI),[26] surgical procedures used,[27] CRS results according to the completeness of cytoreduction (CC) score,[26] HIPEC techniques and drugs, number of adjuvant and neoadjuvant chemotherapy (NACT) cycles, eventual drug-induced toxicity during systemic chemotherapy and HIPEC evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 4.0)[28] and last complete updated data on follow-up
Summary
The aim of this study was to help with the process of selecting patients with advanced ovarian cancer to undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) by analyzing outcome data at distinct clinical time points reflecting the natural history of the disease
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