Khan O A, Fitzgerald J J, Soomro I, Beggs F D, Morgan W E, Duffy J P
Thoracic Unit, Nottingham City Hospital, Hucknall Road, Nottingham, UK.
Br J Cancer. 2003 May 19;88(10):1549-52. doi: 10.1038/sj.bjc.6600931.
The factors affecting long-term survival following oesophagectomy for oesophageal cancer are poorly understood. We examined the significance of microscopic tumour involvement at the circumferential resection margin (CRM) on postoperative survival following oesophagectomy. The case notes of 329 patients who underwent a potentially curative oesophagectomy for squamous or adenocarcinoma were reviewed retrospectively. As part of the procedure, all patients underwent an en-bloc resection of their periesophageal tissue. The presence of tumour either at, or within, 1 mm of the CRM was recorded and correlated with their TNM and survival data. A total of 67 patients (20%) were noted to have a positive CRM, of which 40 cases (12%) had tumour at the resection margin and the remainder had tumour within 1 mm of the margin. Univariate analysis showed no statistically significant association between survival and either category of CRM involvement. Multivariate analysis showed that only T-stage, nodal status and tumour grade were prognostic markers. In conclusion, the presence of microscopic tumour at the CRM following an en-bloc oesophagectomy is not a significant prognostic marker.
食管癌食管切除术后影响长期生存的因素尚不清楚。我们研究了食管切除术后环周切缘（CRM）微小肿瘤累及对术后生存的意义。回顾性分析了329例行潜在根治性食管切除术治疗鳞状细胞癌或腺癌患者的病历。作为手术的一部分，所有患者均行食管周围组织整块切除。记录CRM处或距CRM 1 mm范围内有无肿瘤，并将其与TNM和生存数据进行关联。共67例（20%）患者CRM阳性，其中40例（12%）切缘有肿瘤，其余患者肿瘤位于距切缘1 mm范围内。单因素分析显示，生存与任何一类CRM累及之间均无统计学显著关联。多因素分析显示，只有T分期、淋巴结状态和肿瘤分级是预后标志物。总之，整块食管切除术后CRM处微小肿瘤的存在并非显著的预后标志物。
