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Background <p>Advanced ovarian cancer remains a significant challenge in gynecologic oncology, with a 5-year survival rate of approximately 30% for patients with advanced disease. The use of surgery is the standard of care for advanced ovarian cancer.</p> Aim <p>This meta-analysis aims to detect the efficacy and safety of Hyperthermic intraperitoneal chemotherapy (HIPEC) as an adjunct to surgery for advanced ovarian cancers.</p> Methods <p>We systematically searched PubMed, Embase, Clinicaltrials.gov, and the Cochrane databases from inception till 10 Jan 2025, focusing on randomized controlled trials (RCTs) reporting therapeutic and safety outcomes of integrating HIPEC to surgery for advanced ovarian cancers. Dichotomous outcomes were presented as risk ratios (RR) with 95% confidence intervals (CI). The inter-study heterogeneity was dealt with using the random effect model. All the calculations were performed using RevMan 5.4. A <i>P</i> value of &lt; 0.05 was considered statistically significant.</p> Results <p>This meta-analysis included nine RCTs with 1,545 patients comparing HIPEC plus surgery (n = 770) with surgery alone (n = 775). No significant difference was observed in overall survival (OS) at one year (RR = 1.02, 95% CI: 0.99–1.05, <i>p</i> = 0.11) or three years (RR = 1.08, 95% CI: 1.00–1.17, <i>p</i> = 0.06), but a significant benefit was seen at five years (RR = 1.27, 95% CI: 1.09–1.49, <i>p</i> = 0.003), while OS at seven years remained non-significant (RR = 1.39, 95% CI: 0.93–2.09, <i>p</i> = 0.11). However, after sensitivity analysis, OS improvement at 7&#xa0;years showed significant values (RR = 1.83, 95% CI: [1.32, 2.52]; <i>P</i> = 0.0003). Progression-free survival (PFS) showed no significant differences at one year (RR = 1.12, 95% CI: 0.97–1.29, <i>p</i> = 0.14), three years (RR = 1.24, 95% CI: 0.87–1.79, <i>p</i> = 0.24), five years (RR = 1.01, 95% CI: 0.67–1.54, <i>p</i> = 0.95), or seven years (RR = 1.10, 95% CI: 0.77–1.58, <i>p</i> = 0.61). PFS at 1&#xa0;year showed significant improvement with HIPEC after sensitivity analysis (RR = 1.21, 95% CI: [1.09, 1.34]; <i>P</i> = 0.0003). HIPEC plus surgery was associated with a higher risk of thrombocytopenia and sepsis, while other adverse events showed no significant differences.</p> Conclusion <p>This meta-analysis suggests that adding HIPEC to surgery for advanced ovarian cancer improves overall survival at five years but not at earlier or later time points. Progression-free survival showed no significant benefit. However, it exhibited an increased OS at 7&#xa0;years and PFS at one year after performing sensitivity analysis to reduce heterogeneity. HIPEC was associated with a higher risk of thrombocytopenia and sepsis, while other adverse events remained comparable.</p>

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Hyperthermic Intraperitoneal Chemotherapy + Surgery Versus Surgery Alone for Ovarian Cancer, a Systematic Review and Meta Analysis of RCTs

  • 期刊论文

  • 发表日期：

    2025年10月15日

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  • Abdullah AFRIDI,
  • Umama ALAM,
  • Muhammad Abdullah ALI,
  • Umaima CHEEMA,
  • Iqra KHAN,
  • Hassan IJAZ,
  • Areej DAR,
  • Asad IQBAL,
  • Ayesha FAROOQ,
  • Mizhgan ABID,
  • Momina ALI,
  • Farwa NISA,
  • Zaryab BACHA,
  • Fazia KHATTAK,
  • Maheez SHERAZ,
  • Mian Zahid Jan KAKAKHEL,
  • Muhammad Usman HAIDER

摘要

Background

Advanced ovarian cancer remains a significant challenge in gynecologic oncology, with a 5-year survival rate of approximately 30% for patients with advanced disease. The use of surgery is the standard of care for advanced ovarian cancer.

Aim

This meta-analysis aims to detect the efficacy and safety of Hyperthermic intraperitoneal chemotherapy (HIPEC) as an adjunct to surgery for advanced ovarian cancers.

Methods

We systematically searched PubMed, Embase, Clinicaltrials.gov, and the Cochrane databases from inception till 10 Jan 2025, focusing on randomized controlled trials (RCTs) reporting therapeutic and safety outcomes of integrating HIPEC to surgery for advanced ovarian cancers. Dichotomous outcomes were presented as risk ratios (RR) with 95% confidence intervals (CI). The inter-study heterogeneity was dealt with using the random effect model. All the calculations were performed using RevMan 5.4. A P value of < 0.05 was considered statistically significant.

Results

This meta-analysis included nine RCTs with 1,545 patients comparing HIPEC plus surgery (n = 770) with surgery alone (n = 775). No significant difference was observed in overall survival (OS) at one year (RR = 1.02, 95% CI: 0.99–1.05, p = 0.11) or three years (RR = 1.08, 95% CI: 1.00–1.17, p = 0.06), but a significant benefit was seen at five years (RR = 1.27, 95% CI: 1.09–1.49, p = 0.003), while OS at seven years remained non-significant (RR = 1.39, 95% CI: 0.93–2.09, p = 0.11). However, after sensitivity analysis, OS improvement at 7 years showed significant values (RR = 1.83, 95% CI: [1.32, 2.52]; P = 0.0003). Progression-free survival (PFS) showed no significant differences at one year (RR = 1.12, 95% CI: 0.97–1.29, p = 0.14), three years (RR = 1.24, 95% CI: 0.87–1.79, p = 0.24), five years (RR = 1.01, 95% CI: 0.67–1.54, p = 0.95), or seven years (RR = 1.10, 95% CI: 0.77–1.58, p = 0.61). PFS at 1 year showed significant improvement with HIPEC after sensitivity analysis (RR = 1.21, 95% CI: [1.09, 1.34]; P = 0.0003). HIPEC plus surgery was associated with a higher risk of thrombocytopenia and sepsis, while other adverse events showed no significant differences.

Conclusion

This meta-analysis suggests that adding HIPEC to surgery for advanced ovarian cancer improves overall survival at five years but not at earlier or later time points. Progression-free survival showed no significant benefit. However, it exhibited an increased OS at 7 years and PFS at one year after performing sensitivity analysis to reduce heterogeneity. HIPEC was associated with a higher risk of thrombocytopenia and sepsis, while other adverse events remained comparable.