Does hyaluronic acid stimulate tumor growth after endoscopic mucosal resection?
OBJECTIVE
A submucosal injection of sodium hyaluronate is widely used for mucosal elevation in endoscopic mucosal resection (EMR) or endoscopic submucosal dissection procedures; however, the oncologic safety of sodium hyaluronate remains unknown. Hyaluronate is the main ligand for CD44 and this interaction was reported to promote tumor progression in in vitro or animal studies. This study aimed to evaluate the effects of sodium hyaluronate on tumor growth after EMR for gastrointestinal cancers.


METHODS
The study included 18 consecutive patients who underwent surgery for locally-recurrent or remnant gastrointestinal cancers after EMR from January 2001 to December 2006. The immunohistochemical expression levels of Ki-67, CD44, ErbB2, and epidermal growth factor receptor (EGFR) were evaluated in the primary tumor tissue and the recurrent tumor. The protein expression in recurrent or remnant lesions was also compared between the sodium hyaluronate group and non-sodium hyaluronate group.


RESULTS
Sodium hyaluronate was used in nine of 14 cases with EMR for gastric cancers and in one of four cases for colon cancers. The time to operation after EMR was 133 days (5-687 days). An analysis of the immunohistochemical expression levels between primary and recurrent or remnant tumors showed no significant differences in the expression levels of Ki-67, CD44, ErbB2, and EGFR with or without sodium hyaluronate.


CONCLUSIONS
We found no evidence that sodium hyaluronate stimulates the growth of remnant tumors after EMR.
Sohn
Dae Kyung
DK
Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Chang
Hee Jin
HJ
Choi
Hyo Seong
HS
Jeong
Seung-Yong
SY
Kook
Myeong-Cherl
MC
Kim
Chan Gyoo
CG
Choi
Il Ju
IJ
D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D016145:Endoscopy, Digestive System; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects*; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000601:surgery*
D000276:Adjuvants, Immunologic; D006820:Hyaluronic Acid