부산대학교 도서관

Objectives: To determine if hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival in patients undergoing cytoreductive surgery (CRS) for newly diagnosed stage III or stage IV ovarian cancer at Commission on Cancer (CoC)-accredited cancer programs in the United States. Methods: The National Cancer Database was queried for patients with stage III or stage IV ovarian cancer undergoing CRS+HIPEC between 2004 and 2017. A control population of patients from 38 HIPEC-performing institutions undergoing CRS only was obtained using propensity score matching and adjusted for facility volume, age, Charlson-Deyo-Comorbidity-Index (CDCI), and stage. All patients in this study underwent complete cytoreduction to no gross residual (NGR) disease. Univariate survival analyses were performed using the log-rank test and adjusted for covariates using Cox proportional hazards regression. All analyses were performed using IBM SPSS Statistics 27. Results: A total of 66 patients who underwent CRS+HIPEC and had available survival data were identified. An additional 66 patients who underwent CRS only at HIPEC performing institutions were included in all comparisons based on propensity score match parameters. Demographics for the CRS+HIPEC group versus the CRS only group revealed no significant difference between median age (58 vs 61 years old) or median CDCI (score 0 vs 0), while significant differences were observed in primary CRS (46% vs 76%) (p<0.001), interval CRS (54% vs 24%) (p<0.001), stage III (65% vs 82%) (p=0.007), and stage IV (35% vs 18%) (p=0.007). Patients undergoing CRS+HIPEC had a significantly higher median overall survival (OS) of 42.1 months (95% CI: 31.8-52.4 months) compared to patients undergoing CRS only, who had a median OS of 34.9 months (95% CI: 23.4-46.4 months, p=0.015). Fifty percent of patients undergoing CRS+HIPEC were still alive at 60 months compared to 30.3% of patients undergoing CRS only. On multivariable analysis, patients undergoing CRS+HIPEC were 38.9% less likely to die compared to those who underwent CRS alone (HR of death: 0.611, 95% CI 0.402-0.928, p=0.021). [Display omitted] Conclusions: On retrospective review of patients undergoing complete CRS for newly diagnosed stage III or stage IV ovarian cancer at CoC-accredited cancer programs in the United States, we found CRS+HIPEC to be associated with significantly improved survival compared to CRS only. These findings are especially notable given the higher proportion of stage IV patients in the CRS+HIPEC group. Thus, stage IV patients who respond well to neoadjuvant chemotherapy and can undergo complete interval CRS should also be considered for HIPEC. [ABSTRACT FROM AUTHOR]