Efficacy Of Hyperthermic Intraperitoneal Chemotherapy In Patients With Epithelial Ovarian Cancer:a Meta-analysis

Obiective:The role of hyperthermic intraperitoneal chemotherapy(HIPEC)in epithelial ovarian cancer(EOC)is still controversial.Present analysis aims to evaluate the survival benefit of HIPEC in treatment of EOC patients.Methods:Articles related to 'HIPEC' and 'ovarian cancer' were comprehensively searched in four databases(PubMed,EMBASE,MEDLINE and Cochrane Library)up to Feb 4,2018.There were no language restrictions.Eligible comparative studies were identified depending on the selection criteria.To include all potentially eligible studies,the references of identified articles were also checked by manual search.The following data were collected:survival outcome(including the 1-,2-,3-,4-and 5-year rate of survival,hazard ratio(HR),odds ratio(OR)and 95%Confidence Interval(CI)),morbidity(related to HIPEC or CRS)and mortality(within 30 days after surgery).The Newcastle-Ottawa Scale(NOS)and Jadad scale were employed for quality assessment of included studies.The relationship between HIPEC and survival of EOC was assessed using random-effects models.Publication bias was assessed by funnel plot and Egger' s linear regression test.Sensitivity analysis was performed to explore robustness of the findings.All statistical analyses were performed with the STATA 12.0.Results:A total of 1,464 patients from 17 trials were subjected to analysis.Fourteen studies(n=1,227)investigated the relationship between HIPEC and overall survival(OS)of EOC.Ten studies(n=1,031)assessed the relationship between HIPEC and progression-free survival(PFS)of EOC.The pooled results showed that HIPEC significantly improved overall survival(OS,HR=0.50,95%CI 0.36-0.69;p=0.000)and progression-free survival(PFS,HR=0.57,95%CI 0.47-0.69;p=0.000)among EOC patients when compared with no HIPEC controls.Similar results were observed in 1-,2-,3-,4-,5-year rate of OS(OR=2.82,95%CI 1.54-5.18;2.67,1.83-3.91;3.02,1.82-4.99;2.33,1.50-3.63 and 2.48,1.71-3.61.p=0.001,0.000,0.000,0.000 and 0.000 respectively)and 1-,2-,3-,4-,5-year rate of PFS(OR=1.87,95%CI 1.23-2.82;2.79,1.91-4.07;2.52,1.78-3.57;3.12,1.84-5.30 and 2.19,1.45-3.31.p=0.003,0.000,0.000,0.000 and 0.000 respectively).Subgroup analysis didn't lead to the opposite results,except no significant increased 1-year of OS(OR=1.78,95%CI 0.86-3.68,p=0.120)in primary EOC and 1-and 2-year of PFS(OR=1.46,95%CI 0.50-4.28 and 2.48,0.88-7.04.p=0.495 and 0.087 respectively)in recurrent EOC treated with HIPEC were observed.Conclusions:HIPEC is associated with improved OS and PFS in both primary and recurrent EOC.However,due to the limitations of meta-analysis,further prospective randomized controlled trials are warranted.