Hyperthermic intraperitoneal chemotherapy combined with cytoreductive surgery versus cytoreductive surgery alone for ovarian cancer: An updated meta-analysis.

Abstract

5543 Background: Hyperthermic Intraperitoneal Chemotherapy (HIPEC) delivers high-dose chemotherapy directly to the abdominal cavity to treat cancers that have spread to the peritoneal lining. When combined with cytoreductive surgery (CRS), HIPEC has been shown to improve survival outcomes in patients with advanced and recurrent ovarian cancer. This updated meta-analysis compares the efficacy and adverse events of CRS with HIPEC to cytoreductive surgery alone. Methods: A comprehensive literature search was conducted across Medline, Embase, Google Scholar, Cochrane CENTRAL, Scopus, and ClinicalTrials.gov up to December 2024. Only observational studies and randomized controlled trials (RCTs) involving adult patients with advanced or recurrent ovarian cancer treated with HIPEC in combination with CRS were included. The primary outcomes assessed were overall survival and the incidence of grade 3 or higher adverse events. A meta-analysis using a fixed-effects model was performed to calculate the pooled odds ratio (OR) and pooled hazard ratio (HR), with 95% confidence intervals (CI), to estimate the overall treatment effect. Results: A total of twelve studies involving 1,893 participants were included, with 1,067 participants in the control group and 826 in the treatment group. Regarding overall survival, the pooled HR was 0.67 (95% CI: 0.57–0.78; p<0.00001; I²=42%). In subgroup analyses, the HR was 0.67 (95% CI: 0.54–0.83) for treatment-naïve patients and 0.66 (95% CI: 0.52–0.84) for patients undergoing secondary cytoreduction for recurrent ovarian cancer. The test for subgroup differences showed no significant heterogeneity (I²=0%). In terms of adverse events, the pooled OR was 1.01 (95% CI: 0.89–1.14; p<0.00001; I²=82%). Conclusions: This updated meta-analysis demonstrates that HIPEC combined with CRS significantly improves overall survival in patients with ovarian cancer. Subgroup analysis indicated that this treatment enhances survival in both treatment-naïve patients and those undergoing secondary cytoreduction for recurrent ovarian cancer, aligning with findings from previous meta-analysis. However, in contrast to earlier meta-analysis, this study shows that HIPEC plus CRS does not increase the risk of adverse events. Therefore, HIPEC combined with CRS is both an effective and safe treatment option for patients with advanced and recurrent ovarian cancer.