From evidence to practice: national patterns of hyperthermic intra-peritoneal chemotherapy use and survival in...

This study aimed to characterize national trends in hyperthermic intra-peritoneal chemotherapy utilization and associated survival outcomes among patients with stage III high-grade serous ovarian cancer undergoing interval cytoreductive surgery following the OVHIPEC-1 trial.

A retrospective cohort study using the National Cancer Database. Women diagnosed with stage III high-grade serous ovarian cancer who underwent interval cytoreductive surgery, with or without hyperthermic intra-peritoneal chemotherapy, between 2004 and 2022 were included. hyperthermic intra-peritoneal chemotherapy utilization trends were assessed relative to the 2018 OVHIPEC-1 publication. Survival was analyzed with Kaplan-Meier and Cox proportional-hazards models adjusted for age, stage, and comorbidity. Sensitivity analysis was performed for propensity-matched cohort, and for a cohort restricted to patients treated at centers performing hyperthermic intra-peritoneal chemotherapy.

Among 15,946 women included, 335 (2.1%) received hyperthermic intra-peritoneal chemotherapy. Hyperthermic intra-peritoneal chemotherapy utilization was 1.4% before 2018 and 3.2% thereafter, with a 61% relative increase from 2018 to 2022, and an average annual percent change increase of 12.6% (p < .001). The median overall survival for hyperthermic intra-peritoneal chemotherapy cases was 66 months (95% confidence interval 56.7 to 75.2) versus 42 months (95% confidence interval 41.2 to 42.7), log rank p < .001. Cox regression adjusted for age, race, residual disease, and Charlson-Deyo comorbidity score-hyperthermic intra-peritoneal chemotherapy was associated with reduced risk of death; hazard ratio 0.71 (95% confidence interval 0.59 to 0.84). Following propensity matching for patients age, race, insurance type, median income, residual disease, and comorbidity score-hyperthermic intra-peritoneal chemotherapy was associated with a significantly longer median overall survival; 66 months (95% confidence interval 56.7 to 75.2) versus 45 months (95% confidence interval 39.9 to 50.1), log rank p = .013. When the analysis was restricted to patients treated at centers performing hyperthermic intra-peritoneal chemotherapy, it was associated with a significantly longer median overall survival; 66 months (95% confidence interval 56.7 to 75.2) versus 44 months (95% confidence interval 42.5 to 45.4), log rank p < .001. Hyperthermic intra-peritoneal chemotherapy was associated with a longer hospital stay and higher rates of 30-day readmission and mortality.

Hyperthermic intra-peritoneal chemotherapy adoption, although limited nationally, has increased modestly since OVHIPEC-1, with probable survival benefits for selected patients. Translating pivotal trial evidence into widespread clinical practice continues to face implementation barriers.