Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
J Surg Oncol. 2013 Jun;107(7):762-6. doi: 10.1002/jso.23313. Epub 2012 Dec 31.
To analyze treatment outcomes and patterns of recurrence, and to examine the impact of adjuvant postoperative radiotherapy (PORT) after esophagectomy in esophageal squamous cell carcinoma (SqCC) regarding the status of circumferential resection margin (CRM).
We performed a retrospective review of esophageal cancer patients operated in Seoul National University Hospital between 2003 and 2010. Pathologically proven T3 SqCC patients with written reports mentioning the status of CRM were selected. Fifty-nine out of 71 patients (83.1%) had CRM+. Twenty-eight patients had radiotherapy in CRM+ and CRM-, respectively. The median follow-up period was 17.1 months (range: 5.2-63.1).
Median survival and 2-year overall survival were 13.8 months and 41.9% in CRM+, and 27.3 months and 74.1% in CRM-, respectively. Loco-regional relapse-free survival (LRRFS) rate at 2 years was 33.6% and 74.1% in each groups (P = 0.029). Loco-regional recurrence was the major pattern of failure in CRM+. PORT did not improve LRRFS.
The esophageal SqCC patients with CRM+ after resection showed worse LRRFS. This finding validated the prognostic value of CRM status. Nevertheless, we failed to demonstrate the benefits of adjuvant PORT in CRM+. This might suggest the necessity of neoadjuvant therapy to decrease the CRM+ rate after esophagectomy.
分析治疗结果和复发模式，并检查食管癌（SqCC）术后辅助放疗（PORT）对环周切缘（CRM）状态的影响。
我们对 2003 年至 2010 年期间在首尔国立大学医院接受手术的食管癌患者进行了回顾性分析。选择了病理证实为 T3SqCC 且 CRM 状态有书面报告的患者。71 例患者中有 59 例（83.1%）CRM+。28 例患者分别在 CRM+和 CRM-中进行了放疗。中位随访时间为 17.1 个月（范围：5.2-63.1）。
CRM+的中位生存期和 2 年总生存率分别为 13.8 个月和 41.9%，CRM-的分别为 27.3 个月和 74.1%。2 年时局部区域无复发生存率（LRRFS）分别为 33.6%和 74.1%（P=0.029）。CRM+患者复发模式主要为局部区域复发。PORT 并不能改善 LRRFS。
切除后 CRM+的食管 SqCC 患者局部区域无复发生存率较差。这一发现验证了 CRM 状态的预后价值。然而，我们未能证明 CRM+辅助 PORT 的益处。这可能表明在食管癌手术后需要新辅助治疗以降低 CRM+的发生率。
