KELIM score and BRCA status are unreliable to predict the completeness of cytoreduction during interval debulking surgery with hyperthermic intraperitoneal chemotherapy for ovarian cancers
The gold standard for treating primary advanced ovarian, primary peritoneal, and fallopian tubal cancers (OC) is optimal debulking surgery plus adjuvant chemotherapy. Neoadjuvant chemotherapy followed by optimal interval debulking surgery (NACT/IDS) with hyperthermic intraperitoneal chemotherapy (HIPEC) provides better survival outcomes than without HIPEC in current literature. The modeled CA-125 elimination rate constant k (KLEM) score reflects the response of NACT before IDS. A BRCA mutation may indicate a better response to chemotherapy and improved outcomes in OC. However, the correlation between these two factors and the completeness of cytoreduction (CC) during IDS/HIPEC has been less extensively discussed. We retrospectively enrolled 17 HIPEC cases, including 10 NACT/IDS and seven secondary cytoreductive surgery (SCS) cases after database searching and chart review. The KELIM score was calculated in the NACT/IDS group for predicting the residual status of surgery. The survivorship between NACT/IDS and SCS was similar. There is no major surgical complication, morbidity or mortality after HIPEC. In the IDS group, five cases reached CC scores of 0 (however, two of these cases had an unfavorable KELIM score), four cases reached a CC of 1, and one case had a CC of 2, but with a favorable KELIM score. In the SCS group, three cases reached a CC of 0, two reached a CC of 1, and two reached a CC of 2. There was no serious post-operative morbidity or mortality after HIPEC. The KELIM score showed a weak correlation with the CC score. Two cases with BRCA 1/2 mutation showed unfavorable KELIM scores and only one case reached CC of 0. After the maturation of the HIPEC techniques, this procedure is safe and feasible. Currently, there are no reliable pre-operative markers, including KELIM score or BRCA1/2 status, which could predict the CC score after surgery.