Does Adding HIPEC to Cytoreductive Surgery Improve Outcomes in Patients With Gastric Cancer and Peritoneal Metastases?
In a propensity score analysis reported in the Journal of Clinical Oncology, Bonnot et al found that the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery improved outcomes among patients with gastric cancer with peritoneal metastases.
The study included 277 patients from prospective databases who were treated with complete cytoreductive surgery with curative intent (no residual nodules > 2.5 mm) at 19 French sites between 1989 and 2014. Of these, 180 underwent cytoreductive surgery/HIPEC and 97 received cytoreductive surgery alone. A Cox proportional hazards regression model with inverse probability of treatment weighting (IPTW) based on propensity score was used to account for confounding factors.
Treatment Outcomes
After IPTW adjustment, the median peritoneal cancer index remained higher in the cytoreductive surgery/HIPEC group (6 vs 2, P = .003). In IPTW analysis, median overall survival was 18.8 months in the cytoreductive surgery/HIPEC group vs 12.1 months in the cytoreductive surgery alone group, and 3- and 5-year overall survival rates were 26.2% vs 10.8% and 19.9% vs 6.4%, respectrively (adjusted hazard ratio = 0.60, P = .005). Recurrence-free survival at 3 and 5 years was 20.4% vs 5.9% and 17.1% vs 3.8% (P = .001). No significant differences between groups were found in 90-day mortality (7.4% vs 10.1%, P = .820) or major complication rate (53.7% vs 55.3%, P = .496).
The investigators concluded, “Compared with cytoreductive surgery [alone], cytoreductive surgery/HIPEC improved [overall survival] and recurrence-free survival, without additional morbidity or mortality. When complete cytoreductive surgery is possible, cytoreductive surgery/HIPEC may be considered a valuable therapy for strictly selected patients with limited [peritoneal metastases] from [gastric cancer].”
Olivier Glehen, MD, PhD, of the Department of Surgical Oncology, CHU Lyon Sud, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: For full disclosures of the study authors, visit jco.ascopubs.org.
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