Comparative oncological efficacy of chemotherapy, cytoreductive surgery with or without HIPEC in recurrent ovarian cancer: A network meta-analysis.
Richard Sassun, Shigeki Kusamura, Dario Carlo Angelo Baratti et al.
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In 30 seconds
This systematic review and network meta-analysis compared chemotherapy (CHT), secondary cytoreductive surgery (SCS), and SCS with hyperthermic intraperitoneal chemotherapy (HIPEC) for platinum-sensitive recurrent ovarian cancer. It included five randomised trials and 1831 patients. Neither SCS nor SCS + HIPEC significantly improved 5-year overall survival (OS) versus CHT in the main analysis. Both were associated with longer 5-year progression-free survival (PFS): SCS HR 0.75, 95% CI 0.63-0.88; SCS + HIPEC HR 0.71, 95% CI 0.53-0.94. The SCS + HIPEC comparison with CHT was indirect.
Key findings
- Neither SCS (HR 0.97, 95% CI 0.80-1.19) nor SCS + HIPEC (HR 0.76, 95% CI 0.54-1.08) significantly improved 5-year OS versus CHT.
- Both SCS and SCS + HIPEC significantly prolonged 5-year PFS versus CHT: HR 0.75, 95% CI 0.63-0.88, and HR 0.71, 95% CI 0.53-0.94, respectively.
- Excluding GOG-0213, SCS + HIPEC significantly improved OS (HR 0.65, 95% CI 0.44-0.94, p = 0.023).
- In CC-0 patients, both surgical approaches improved OS and PFS versus CHT; findings for CC-1 patients were exploratory.
Why it matters
The analysis suggests that secondary surgery, with or without HIPEC, may extend disease control in selected patients, while an overall-survival advantage is not established in the main comparison. Distinguishing PFS from OS and recognising the uncertainty around indirect comparisons can help frame discussions of treatment evidence without overstating the benefit of surgery or HIPEC.
What to keep in mind
The SCS + HIPEC versus CHT comparison relies on indirect evidence, and the authors note possible bias because CHIPOR used neoadjuvant chemotherapy. The OS analysis showed heterogeneity (I 2 = 68.4%).