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Descriptive Review of Current Practices and Prognostic Factors in Patients with Ovarian Cancer Treated by Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC): a Multicentric, Retrospective, Cohort of 234 Patients.

Frontiers in Oncology(2023)

Ctr Hosp Lyon Sud | Zydus Hosp | Clin Pilar | Moscow Res Oncol Inst | Univ Lausanne UNIL | Univ Hosp Tubingen | Univ Hosp Leipzig | Univ Montpellier | Ghent Univ Hosp | Agostino Gemelli University Polyclinic | Fdn Policlin | Candiolo Cancer Institute

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Abstract
Introduction:Ovarian cancer (OC) is the primary cause of mortality in women diagnosed with gynecological cancer. Our study assessed pressurized intraperitoneal aerosol chemotherapy (PIPAC) as treatment for peritoneal surface metastases (PSM) from recurrent or progressive OC and conducted survival analyses to identify prognostic factors.Material and methods:This retrospective cohort study, conducted across 18 international centers, analyzed the clinical practices of patients receiving palliative treatment for PSM from OC who underwent PIPAC. All patients were initially treated appropriately outside any clinical trial setting. Feasibility, safety, and morbidity were evaluated along with objective endpoints of oncological response. Multivariate analysis identified prognostic factors for OS and PFS.Results:From 2015-2020, 234 consecutive patients were studied, from which 192 patients were included and stratified by platinum sensitivity for analysis. Patients with early recurrence, within one postoperative month, were excluded. Baseline characteristics were similar between the groups regarding platinum sensitivity (platinum sensitive (PS) and resistant (PR)), but chemotherapy frequency differed, as did PCI before PIPAC. Median PCI decreased in both groups after three cycles of PIPAC (PS 16 vs. 12, p < 0.001; PR 24 vs. 20, p = 0.009). Overall morbidity was 22%, with few severe complications (4-8%) or mortality (0-3%). Higher pathological response and longer OS (22 vs. 11m, p = 0.012) and PFS (12 vs. 7m, p = 0.033) were observed in the PS group. Multivariate analysis (OS/PFS) identified ascites (HR 4.02, p < 0.001/5.22, p < 0.001), positive cytology at first PIPAC (HR 3.91, p = 0.002/1.96, p = 0.035), and ≥ 3 PIPACs (HR 0.30, p = 0.002/0.48, p = 0.017) as independent prognostic factors of overall survival/progression-free survival.Conclusions:With low morbidity and mortality rates, PIPAC is a safe option for palliative treatment of advanced ovarian cancer. Promising results were observed after 3 PIPAC, which did improve the peritoneal burden. However, further research is needed to evaluate the potential role of PIPAC as an independent prognostic factor.
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peritoneal metastases,ovarian cancer,PIPAC,prognostic factors,platinum sensitivity
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要点】:本研究评估了压力下腹腔内气溶胶化疗(PIPAC)对复发性或进展性卵巢癌腹膜表面转移(PSM)的治疗效果,并分析了影响生存期的预后因素,发现PIPAC是一种安全的治疗选择,且与预后相关的重要因素包括腹水、首次PIPAC时的阳性细胞学结果以及至少进行3次PIPAC。

方法】:通过18个国际中心的回顾性队列研究,分析了接受PIPAC治疗的PSM患者的临床实践。

实验】:2015至2020年间研究了234例连续患者,其中192例被纳入分析,并按铂敏感性分层。研究评估了可行性、安全性、发病率以及客观的肿瘤学反应终点。结果显示,两组基线特征相似,但化疗频率和PIPAC前的PCI有所不同。三次PIPAC后,两组的PCI中位数均有所下降。总体病发率为22%,严重并发症和死亡率较低。在铂敏感组中观察到更高的病理反应率和更长的总生存期(22个月 vs 11个月)和无进展生存期(12个月 vs 7个月)。多变量分析确定腹水、首次PIPAC时的阳性细胞学结果以及至少进行3次PIPAC为独立的预后因素。