Table 4_Hyperthermic intraperitoneal chemotherapy enhances survival outcomes in primary ovarian cancer following cytoreductive surgery: a systematic review and meta-analysis.docx

BackgroundThis study aimed to evaluate the therapeutic effect of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with primary ovarian cancer (OC) following cytoreductive surgery (CRS).
MethodsFollowing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, Web of Science, Embase, and the Cochrane Library from inception to May 2025. The outcomes were progression-free survival (PFS) and overall survival (OS). Treatment effects were quantified using pooled hazard ratios (HRs) with 95% confidence intervals (95%CIs).
ResultsThis meta-analysis included 10 studies [three randomized controlled trials (RCTs) and seven observational studies] involving 1,668 patients. Patients with primary OC undergoing CRS who received HIPEC treatment in the experimental group demonstrated prolonged PFS (HR = 0.45, 95%CI = 0.29–0.69, p < 0.001, I2 = 77.3%) and OS (HR = 0.59, 95%CI = 0.45–0.78, p < 0.001, I2 = 60.6%) outcomes compared with the controls. In the experimental group, better PFS benefits were observed in Western populations, observational studies, interval cytoreductive surgery (ICS), and in patients with Eastern Cooperative Oncology Group (ECOG) 0–1. HIPEC was beneficial for patients with OC regardless of follow-up time ≥5 years (HR = 0.68, 95%CI = 0.49–0.96, p = 0.026) or <5 years (HR = 0.29, 95%CI = 0.13–0.63, p = 0.002), with a greater magnitude of benefit observed in the subgroup with follow-up <5 years. The subgroup analyses for OS revealed a consistent benefit of HIPEC across Western population, follow-up time ≥5 years, ICS, and ECOG 0–1. Benefit was associated with HIPEC in both RCT (HR = 0.75, 95%CI = 0.60–0.94, p = 0.013) and observational analyses (HR = 0.47, 95%CI = 0.33–0.68, p = 0.001), while the observed effect size was larger in the latter. Conversely, HIPEC was associated with a significant OS detriment in patients with an ECOG performance status of 2–3 (HR = 2.37, 95%CI = 1.07–5.23, p = 0.033).
ConclusionHIPEC appears beneficial to the prognosis of patients with primary OC following CRS, particularly after ICS. However, the administration of HIPEC in patients with ECOG 2–3 requires careful clinical consideration.
Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420251036731.

## 背景
本研究旨在评估肿瘤细胞减灭术（cytoreductive surgery, CRS）后，腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy, HIPEC）对原发性卵巢癌（primary ovarian cancer, OC）患者的治疗效果。

## 方法
本研究遵循系统评价与Meta分析优先报告条目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）指南，检索PubMed、Web of Science、Embase及Cochrane Library自建库至2025年5月的相关文献。本研究的结局指标为无进展生存期（progression-free survival, PFS）与总生存期（overall survival, OS），采用合并风险比（pooled hazard ratios, HRs）及95%置信区间（95% confidence intervals, 95%CIs）量化治疗效应。

## 结果
本Meta分析共纳入10项研究，包含3项随机对照试验（randomized controlled trials, RCTs）与7项观察性研究，共计1668例患者。相较于对照组，试验组（接受腹腔热灌注化疗（HIPEC）的原发性卵巢癌（OC）患者且已行肿瘤细胞减灭术（CRS））的无进展生存期（PFS）显著延长（HR=0.45，95%CI=0.29–0.69，p<0.001，I²=77.3%），总生存期（OS）亦得到改善（HR=0.59，95%CI=0.45–0.78，p<0.001，I²=60.6%）。
亚组分析显示，试验组在西方人群、观察性研究、间隔性肿瘤细胞减灭术（interval cytoreductive surgery, ICS）以及东部肿瘤协作组（Eastern Cooperative Oncology Group, ECOG）体能状态0~1分的患者中，无进展生存期（PFS）获益更为显著。无论随访时间≥5年（HR=0.68，95%CI=0.49–0.96，p=0.026）还是<5年（HR=0.29，95%CI=0.13–0.63，p=0.002），腹腔热灌注化疗（HIPEC）均对卵巢癌患者有益，且随访时间<5年的亚组获益幅度更大。
总生存期（OS）的亚组分析显示，腹腔热灌注化疗（HIPEC）在西方人群、随访时间≥5年、间隔性肿瘤细胞减灭术（ICS）以及东部肿瘤协作组（ECOG）体能状态0~1分的患者中均展现出一致的获益。随机对照试验（RCTs）亚组（HR=0.75，95%CI=0.60–0.94，p=0.013）与观察性研究亚组（HR=0.47，95%CI=0.33–0.68，p=0.001）均证实腹腔热灌注化疗（HIPEC）的获益，且后者的效应量更大。与之相反，东部肿瘤协作组（ECOG）体能状态2~3分的患者接受腹腔热灌注化疗（HIPEC）后，总生存期（OS）出现显著恶化（HR=2.37，95%CI=1.07–5.23，p=0.033）。

## 结论
腹腔热灌注化疗（HIPEC）可改善肿瘤细胞减灭术（CRS）后原发性卵巢癌（OC）患者的预后，尤其是在接受间隔性肿瘤细胞减灭术（ICS）的患者中。但对于东部肿瘤协作组（ECOG）体能状态2~3分的患者，临床需谨慎评估腹腔热灌注化疗（HIPEC）的应用。

## 系统评价注册
https://www.crd.york.ac.uk/prospero/，注册编号CRD420251036731。