Long-term survival in patients with epithelial ovarian cancer following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC)

Figures & data

Figure 1. CONSORT 2010 flow diagram.

Table 1. Characteristics of long-term survivors.

Characteristics	Variables	Long-term survivors N = 78
Indication	Advanced epithelial ovarian cancer (EOC)	7 (9.0%)
	Recurrent EOC^a	71 (91.0%)
	Platinum-sensitive	32 (42.1%)
	Platinum-resistant	37 (48.7%)
Histology and grade	High grade serous ovarian cancer (HGSOC)	49 (62.8%)
	Low grade serous ovarian cancer	13 (16.7%)
	Serous ovarian cancer, grade not defined	10 (12.8%)
	Others	6 (7.7%)
Age (years) at the time of the HIPEC	n	78
	median (range)	55.4 (22.6–77.6)
Performance Status (PS) at the time of the first HIPEC^b	0	23 (37.1%)
	1	38 (61.3%)
	2	1 (1.6%)
ASA	ASA1-2	68 (100.0%)
	ASA3-4-5
CA125 before procedure	<30	7 (20.6%)
	[30–100[	9 (26.5%)
	≥100	18 (52.9%)
Peritoneal Cancer Index (PCI)	n	65
	median (range)	7 (0–25)
	0–8	38 (58.5%)
	>8	27 (41.5%)

^a 2 missing data; ^b17 missing data.

Table 2. Treatments and detail of procedures for long-term survivors.

Characteristics	Variables	Long-term survivors
Period of treatment	1991–2005	57 (73.1%)
	2006–2010	21 (26.9%)
Previous chemotherapy	No	4 (5.1%)
	Yes	74 (94.9%)
Number of previous IV chemotherapy	n	65
	Median (range)	6 (1–18)
Previous cytoreduction surgery (CRS)	No	8 (10.3%)
	Yes	70 (89.7%)
Previous debulking	Complete	22 (28.2%)
	Incomplete	42 (53.8%)
	Not performed	8 (10.3%)
	Realized, not defined	6 (7.7%)
Number of previous cytoreduction surgery	n	70
	Median (range)	1 (1–3)
Delay between procedure and initial diagnosis (months)	n	66
	Median (range)	17.53 (0–168.96)
CC-Score	CC-0	60 (76.9%)
	CC-1	11 (14.1%)
	CC-2 low	5 (6.4%)
	CC-2 high	2 (2.6%)
HIPEC technique	Closed	19 (24.4%)
	Open	59 (75.6%)
Duration of HIPEC	n	75
	Median (range)	90 (30-90)
Temperature of HIPEC	n	76
	Median (range)	42.5 (41–45)
Drugs and regimens	Cisplatin	54 (69.2%)
for HIPEC	Doxorubicin	31 (39.7%)
	Oxaliplatin	23 (29.5%)
	Mitomycin	7 (9.0%)
	Cisplatin + Mitomycin	6 (7.7%)
	Cisplatin + Doxorubicin	31 (39.7%)

Figure 2. Survival probability among long-term survivors.

Table 3. Mortality risk factors, univariate analysis.

Variable	Modality	Population	Hazard ratio (95% CI)	p value
Age (years) at the time of first HIPEC	≥50	54 (69.2%)	1.00	.004
	<50	24 (30.8%)	4.2 (1.6–11.1)
Time between diagnosis and HIPEC			0.99 (0.98–1.01)	.26
Number of HIPEC	1	64 (82.1%)	1.00	.08
	2	10 (12.8%)	0 (0-.)
	3	4 (5.1%)	5.1 (1.2–21.1)
Experience of the centre (years)^a	[0–7]	15 (19.2%)	1.00	.83
	]7–11]	33 (42.3%)	1.27 (0.07–22.80)
	>11	30 (38.5%)	0.97 (0.03–27.73)
Peritoneal Cancer Index		Missing data: 13		.049
	[0–8]	38 (58.5%)	1.00
	>8	27 (41.5%)	2.8 (1.0–7.7)
Adjuvant chemotherapy (first HIPEC)		Missing data: 28		.78
	No	36 (72.0%)	1.00
	Yes	14 (28.0%)	1.2 (0.3–4.2)
CA125 at the time of first HIPEC		Missing data: 44		.02
	<30	7 (20.6%)	1.00
	[30–100[	9 (26.5%)	1.1 (0.1–13.3)
	≥100	18 (52.9%)	74.2 (2.5–2216.8)
CC-score at the time of first HIPEC	CC-0	60 (76.9%)	1.00	.057
	CC-1 + CC-2	18 (23.1%)	2.8 (1.0–7.8)
ASA		Missing data: 10		.44
	1	17 (25.0%)	1.00
	2	51 (75.0%)	0.6 (0.2–2.3)
Performance Status (PS) at the time		Missing data: 17		1.00
of the first HIPEC^a	0	23 (37.1%)	1.00
	1	38 (61.3%)	44.3 (1.2–1703.3)
	2	1 (1.6%)	36.2 (0.3–4611.0)
Gilly's groups[1]		Missing data: 51		.40
	0-1-2	12 (44.4%)	1.00
	3–4	15 (55.6%)	2.0 (0.4–10.3)
Indication	Advanced EOC	7 (9.0%)	1.00	.20
	Recurrent EOC	71 (91.0%)	0.3 (0.1–1.8)
Platinum-sensitivity		Missing data: 2		.38
	Platinum-resistant	37 (48.7%)	1.00
	Platinum-sensitive	32 (42.1%)	1.4 (0.5–3.4)
	Advanced frontline	7 (9.2%)	3.5 (0.6–21.2)
Histology and grade	HGSOC	39 (50.0%)	1.00	.45
	Other	39 (50.0%)	1.8 (0.4–8.5)
Number of chemotherapeutic agents (HIPEC)	1	39 (50.0%)	1.00	.58
	2	39 (50.0%)	1.5 (0.3–6.8)
Initial residual disease		Missing data: 14		.64
	No	21 (32.8%)	1.00
	Yes	43 (67.2%)	1.4 (0.4–5.2)
Resection of metastases		Missing data: 4		.48
	No	71 (95.9%)	1.00
	Yes	3 (4.1%)	1.8 (0.3–10.0)

^a with Firth correction [42].

Glehen O, Mithieux F, Osinsky D, et al. Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis: a phase II study. JCO. 2003;21:799–806.

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