Long-Term Survival Advantage and Prognostic Factors Associated With Intraperitoneal Chemotherapy Treatment in Advanced Ovarian Cancer: A Gynecologic Oncology Group Study

• DOI: 10.1200/jco.2014.55.9898
• Publication Date: 2015-03-24T03:17:50Z
• Authors: Devansu Tewari; James J. Java; Ritu Salani; Deborah K. Armstrong; Maurie Markman; Thomas Herzog; Bradley J. Monk; John K. Chan
• Keywords: Ovarian Neoplasms; Chi-Square Distribution; Paclitaxel; Age Factors; Kaplan-Meier Estimate; Carcinoma, Ovarian Epithelial; Middle Aged; Drug Administration Schedule; Carboplatin; 3. Good health; Clinical Trials, Phase III as Topic; Antineoplastic Combined Chemotherapy Protocols; Multivariate Analysis; Odds Ratio; Humans; Female; Infusions, Parenteral; Neoplasms, Glandular and Epithelial; Cisplatin; Infusions, Intravenous; Aged

PurposeTo determine long-term survival and associated prognostic factors after intraperitoneal (IP) chemotherapy in patients with advanced ovarian cancer.Patients and MethodsData from Gynecologic Oncology Group protocols 114 and 172 were retrospectively analyzed. Cox proportional hazards regression models were used for statistical analyses.ResultsIn 876 patients, median follow-up was 10.7 years. Median survival with IP therapy was 61.8 months (95% CI, 55.5 to 69.5), compared with 51.4 months (95% CI, 46.0 to 58.2) for intravenous therapy. IP therapy was associated with a 23% decreased risk of death (adjusted hazard ratio [AHR], 0.77; 95% CI, 0.65 to 0.90; P = .002). IP therapy improved survival of those with gross residual (≤ 1 cm) disease (AHR, 0.75; 95% CI, 0.62 to 0.92; P = .006). Risk of death decreased by 12% for each cycle of IP chemotherapy completed (AHR, 0.88; 95% CI, 0.83 to 0.94; P < .001). Factors associated with poorer survival included: clear/mucinous versus serous histology (AHR, 2.79; 95% CI, 1.83 to 4.24; P < .001), gross residual versus no visible disease (AHR, 1.89; 95% CI, 1.48 to 2.43; P < .001), and fewer versus more cycles of IP chemotherapy (AHR, 0.88; 95% CI, 0.83 to 0.94; P < .001). Younger patients were more likely to complete the IP regimen, with a 5% decrease in probability of completion with each year of age (odds ratio, 0.95; 95% CI, 0.93 to 0.96; P < .001).ConclusionThe advantage of IP over intravenous chemotherapy extends beyond 10 years. IP therapy enhanced survival of those with gross residual disease. Survival improved with increasing number of IP cycles.