UC Irvine

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 p<0.01). 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 >50, Stage IV disease, PS >1, visible residual disease, or interval cytoreduction (all p<0.05). Additionally, major postoperative complications and platinum resistance were associated with shorter OS (p<0.05). 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.