Deeter Matthew, Dorer Russell, Kuppusamy Madhan Kumar, Koehler Richard P, Low Donald E
Department of Thoracic Surgery and Pathology, Virginia Mason Medical Center, Seattle, WA 98111, USA.
Arch Surg. 2009 Jul;144(7):618-24. doi: 10.1001/archsurg.2009.115.
To assess the clinical significance of circumferential resection margins according to current criteria of the College of American Pathologists (CAP) and the Royal College of Pathology (RCP) in esophageal and esophagogastric cancer.
Prospective study.
Single-surgeon database.
One hundred thirty-five patients (mean age, 64 years) with T3 tumors who underwent esophageal resection for cancer between 1991 and 2006. Main Outcome Measure Resection margins criteria and survival.
Three hundred seventy-four consecutive patients were prospectively identified from an institutional review board-approved database between 1991 and 2006. All patients with T3 tumors (n = 135) had their original pathologic slides reassessed by a single gastrointestinal pathologist. Operative mortality was 0.7% and mean follow-up was 3.1 years. Follow-up was complete in 81% of patients. Positive margins were identified in 16 cases in the CAP group vs 83 cases in the RCP group. Five-year Kaplan-Meier survival curves in the CAP group demonstrated a significant (P < .001) difference in survival, whereas the RCP group showed no difference (P = .20). In comparisons of negative vs positive margins, respectively, median survival in the CAP group (29.8 months [95% confidence interval (CI), 22.7-36.9] vs 8.33 months [95% CI, 4.4-12.3]) was significantly different from the RCP group (28.47 months [95% CI, 19.7-37.2] vs 22.23 months [95% CI, 13.6-30.8]). At 60-month follow-up, the positive predictive value with respect to survival was 100% in the CAP group vs 81% in the RCP group. Univariate and multivariate analyses identified R1 margins in the CAP group and lymph node ratio as being directly linked to survival.
Positive circumferential resection margins are prognostically important and the CAP criteria provide a more clinically meaningful assessment. Universal adoption of the CAP system can improve interpretation of international clinical trials and allow more accurate comparisons of outcomes.
根据美国病理学家学会（CAP）和皇家病理学院（RCP）的现行标准，评估食管和食管胃癌环形切缘的临床意义。
前瞻性研究。
单外科医生数据库。
1991年至2006年间因癌症接受食管切除术的135例T3期肿瘤患者（平均年龄64岁）。主要观察指标：切缘标准和生存率。
1991年至2006年间，从一个经机构审查委员会批准的数据库中前瞻性地识别出374例连续患者。所有T3期肿瘤患者（n = 135）的原始病理切片均由一位胃肠道病理学家重新评估。手术死亡率为0.7%，平均随访时间为3.1年。81%的患者随访完整。CAP组有16例切缘阳性，而RCP组有83例。CAP组的五年Kaplan-Meier生存曲线显示生存率有显著差异（P <.001），而RCP组无差异（P = 0.20）。在阴性切缘与阳性切缘的比较中，CAP组的中位生存期（29.8个月[95%置信区间（CI），22.7 - 36.9]与8.33个月[95% CI，4.4 - 12.3]）与RCP组（28.47个月[95% CI，19.7 - 37.2]与22.23个月[95% CI，13.6 - 30.8]）有显著差异。在60个月的随访中，CAP组生存的阳性预测值为100%，而RCP组为81%。单因素和多因素分析确定CAP组的R1切缘和淋巴结比率与生存直接相关。
阳性环形切缘对预后很重要，CAP标准提供了更具临床意义的评估。普遍采用CAP系统可以改善国际临床试验的解读，并使结果比较更准确。
