Does Hyperthermic Intraperitoneal Chemotherapy Improve Survival Outcomes for Patients With Advanced Ovarian Cancer?

A retrospective analysis of the National Cancer Database (NCDB) found no significant survival differences between patients with advanced-stage epithelial ovarian cancer (EOC) treated with hyperthermic intraperitoneal chemotherapy (HIPEC) in combination with neoadjuvant chemotherapy (NACT) and interval cytoreductive surgery (CRS) and those who received NACT and CRS alone. While R0 resection and higher surgical complexity were associated with improved survival within the HIPEC cohort, these factors did not offer an overall survival advantage compared with the non-HIPEC group. This study was presented at the Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer in Seattle, WA.

The addition of HIPEC to NACT and CRS has been associated with improved survival in prior studies, but its use is highly selective and often limited to specialized centers. The current study sought to compare survival outcomes and prognostic factors between patients who underwent HIPEC and those who did not, to better understand the potential benefits of this approach.

Using the NCDB, researchers identified 14,761 patients with advanced-stage EOC who underwent NACT and CRS between 2007 and 2020, of whom 246 received HIPEC. Survival differences between the HIPEC and non-HIPEC groups were analyzed using Kaplan-Meier and Cox proportional hazards regression models, with statistical significance set at P = .05.

The median age of patients undergoing HIPEC was 61 years compared with 65 years in the non-HIPEC group. The median survival was 61.5 months in the HIPEC group and 56.4 months in the non-HIPEC group, a difference that was not statistically significant (P = .21). Survival outcomes did not differ based on treatment at academic versus community-based centers. Within the HIPEC group, survival was positively associated with R0 resection (Odds ratio [OR] = 0.9, P = .02) and high-complexity surgery (OR = 0.6, P = .05). In contrast, the non-HIPEC group demonstrated significant heterogeneity, with differences in age, race, insurance status, Charlson comorbidity index scores, residual disease, and surgical complexity. In this cohort, increased residual disease (OR = 1.4, P < .001) and more complex surgeries (OR = 1.3, P = .001) were linked to worse survival outcomes.

"In the highly selective and homogenous HIPEC group, achieving an R0 resection and performing a high-complexity surgery were associated with improved survival,” the study authors concluded. “However, these benefits did not translate into a significant survival difference when compared to the more heterogeneous group of patients receiving standard treatment without HIPEC."

Reference
Bae C. Prognostic factors impacting survival in patients undergoing hyperthermic intraperitoneal chemotherapy for high-grade ovarian cancer. Paper presented at: Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer; March 14-17, 2025; Seattle, WA. Accessed March 11, 2025. https://www.sgo.org/events/annual-meeting/.