REVIEW article
Front. Oncol.
Sec. Gynecological Oncology
Hyperthermic intraperitoneal chemotherapy enhances survival outcomes in primary ovarian cancer following cytoreductive surgery: a systematic review and meta-analysis
Provisionally accepted
- 1Ningbo No 2 Hospital, Ningbo, China
- 2Zhejiang Chinese Medical University, Hangzhou, China
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Background This study aims to evaluate therapeutic effect of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with primary ovarian cancer (OC) following cytoreductive surgery (CRS). Methods Following PRISMA guidelines, PubMed, Web of Science, Embase and Cochrane Library were searched 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). Results This meta-analysis included 10 studies (3 randomized controlled trials (RCTs), 7 observational studies) involving 1668 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 to controls. In the experimental group, better PFS benefits were observed in west, observational studies, interval cytoreductive surgery (ICS), and Eastern Cooperative Oncology Group (ECOG) 0-1 patients. HIPEC was beneficial for OC patients 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. Subgroup analyses for OS revealed a consistent benefit of HIPEC across west, 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). Conclusion HIPEC appears beneficial prognosis for primary OC patients following CRS, particularly after ICS. However, HIPEC administration in patients with ECOG 2-3 requires careful clinical consideration.
Keywords: ovarian cancer, Hyperthermic intraperitoneal chemotherapy, Cytoreductive surgery, overall survival, Progression-free survival, Meta-analysis
Received: 18 Sep 2025; Accepted: 14 Nov 2025.
Copyright: © 2025 Sun, Hu, Chen, Chen, Xie, Guan and Ying. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qian Sun, leudelimia@163.com
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