Efficacy And Prognostic Factors Of Intraperitoneal Hyperthermic Perfusion Chemotherapy In Patients With Epithelial Ovarian Cancer

Objective:To analyze the clinical efficacy,adverse reactions and prognostic factors of patients with epithelial ovarian cancer after cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC),to provide a basis for the selection of the treatment options.Methods:The clinical data of 59 patients with epithelial ovarian cancer who underwent cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy at the Cancer Center of the First Hospital of Jilin University from January 2009 to December 2017 were selected to analyze the clinical efficacy and adverse reactions.In the initial treatment group,48 cases of first-line treatment were treated with HIPEC combined with intravenous chemotherapy.In the retreatment group,11 cases were treated with intravenous chemotherapy.After relapse,HIPEC combined with intravenous chemotherapy.Subgroup analysis was also performed.Prognostic factors were analyzed using a COX proportional hazard regression model.Results:1.The median progression-free survival 1(PFS1)and median overall survival(OS)of patients with epithelial ovarian cancer were 20 months and 81 months,respectively.The 1-,3-,5-,and 8-year survival rates were 94.9%,74.1%,61.4%,and 35.8%,respectively.The 5-year survival rates of 59 patients in stage II,III,and IV were 88.9%,58.6%,and 50.0%,respectively.The median PFS1 of the patients in the initial treatment group and the retreatment group were 21 months and 9 months,respectively(P=0.006).The median OS in the initial treatment group was not reached,and in the retreatment group was 60 months(P=0.062).2.Analysis of recurrence: The recurrent rate of peritoneal resection after first-line treatment in the initial treatment group and the retreatment group was 35.5% and 54.5%,respectively.3.Adverse reactions after HIPEC treatment include myelosuppression,gastrointestinal reactions,liver and kidney dysfunction,neuropathy,electrolyte imbalance,respiratory diseases,and heart system lesions,most of which are grade I to II,tolerably.Grade III~IV adverse reactions were characterized by leukopenia,neutropenia,hemoglobin reduction,and intestinal obstruction.The incidence rates were 13.56%,15.25%,1.69%,and 1.69%,respectively,and were controllable.4.Univariate analysis: initial FIGO stage,residual disease >1 cm,pre-perfusion CA125>100 U/ml,ascites,lymph node metastasis,peritoneal carcinomatosis index(PCI),and peritoneal surface disease severity score(PSDSS)were prognostic factors for PFS1 in patients wiht epithelial ovarian cancer undergoing HIPEC.Pre-perfusion CA125>100 U/ml,KPS score=80,vascular tumor thrombus,ascites,lymph node metastasis,PCI,and PSDSS were prognostic factors for OS in patients with epithelial ovarian cancer undergoing HIPEC.5.Multivariate analysis: PSDSS was an independent risk factor for PFS1 in patients with epithelial ovarian cancer undergoing HIPEC.KPS score and PSDSS were independent risk factors for OS in patients with epithelial ovarian cancer undergoing HIPEC.6.According to HIPEC treatment timing stratification,the median OS of PSDSS I/II was not reached in the initial treatment group,III/IV was 69 months(P<0.001),and the median OS of PSDSS I/II and III/IV in the retreatment group were 26 months and 22 months,respectively(P=0.712).According to HIPEC perfusion number stratification,the median OS of PSDSS I/II and III/IV in 1~2 group were 91 months and 23 months,respectively(P=0.001),and the median OS of PSDSS I/II in >2 group was not reached,III/IV was 60 months(P=0.100).According to HIPEC perfusion drug stratification,the median OS of PSDSS I/II and III/IV in the single-agent group were 91 months and 22 months,respectively(P=0.021),and the median OS of PSDSS I/II in the double-agent group was not reached,III/IV was 58 months(P=0.013).Conclusion:1.Intraperitoneal hyperthermic perfusion chemotherapy can prolong the progression-free survival of patients with epithelial ovarian cancer and reduce the rate of peritoneal recurrence.2.The adverse reactions of HIPEC treatment mainly showed myelosuppression and gastrointestinal reactions.The main adverse reactions of grade III~IV were myelosuppression and intestinal obstruction,but the incidence was low and controllable.3.Initial FIGO stage,residual disease size,pre-perfusion CA125 level,ascites,lymph node metastasis,PCI,and PSDSS are prognostic factors for PFS1 in patients wiht epithelial ovarian cancer undergoing HIPEC.PSDSS is an independent risk factor.Pre-perfusion CA125 level,KPS score,vascular tumor thrombus,ascites,lymph node metastasis,PCI,and PSDSS are prognostic factors for OS in patients with epithelial ovarian cancer undergoing HIPEC.KPS score and PSDSS are independent risk factors.4.PSDSS can predict the survival of patients with epithelial ovarian cancer undergoing intraperitoneal hyperthermic perfusion chemotherapy and provide valuable information for follow-up.