Analysis of oncologic outcomes associated with anti-adhesion sodium hyaluronate–carboxymethylcellulose (HA–CMC) barrier following optimal or complete cytoreductive surgery for ovarian, fallopian tube, and peritoneal cancers

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Author(s): Krill, Lauren | Advisor(s): Kaplan, Sherrie | Abstract: Objectives: Hyaluronan is a component of the anti-adhesive barrier HA-CMC and has been implicated in tumor growth and metastasis. The study aim was to determine if HA-CMC use is associated with adverse effects on disease progression or survival in patients undergoing surgical cytoreduction for primary treatment of advanced ovarian, fallopian tube, and peritoneal cancers. Methods: Retrospective cohort study of patients undergoing optimal or complete cytoreduction between 1/95-12/08. The primary endpoints were progression free survival (PFS) and overall survival (OS). Fisher's exact test, Kaplan Meier survival analysis, and multivariate Cox proportional hazards regression were utilized. Results: Two hundred eighty-eight cases were analyzed; HA-CMC was utilized in 130 procedures (45%). On univariate analysis, HA-CMC was associated with complete cytoreduction, high surgical complexity score, good performance-status, and being alive at last follow-up (all pl0.01). Neither PFS nor OS was significantly different between subjects with or without HA-CMC (median PFS 16.8 vs 16.4 months, p=0.36; median OS 40.6 vs 36 months, P=0.33). PFS was significantly shorter amongst high-risk subjects, independent of HA-CMC use, with age g50, Stage IV disease, PS g1, visible residual disease, or interval cytoreduction (all pl0.05). Additionally, major postoperative complications and platinum resistance were associated with shorter OS (pl0.05). After controlling for confounding factors using multivariate Cox proportional hazards regression, HA-CMC use did not independently predict PFS (HR 1.1; 95% CI:0.83-1.45) or OS (HR 0.98; 95% CI:0.73-1.32). Conclusions: HA-CMC adhesion barrier placement at the time of primary or interval cytoreductive surgery for ovarian, fallopian tube, and peritoneal cancer does not impact recurrence or survival outcomes.