定义食管癌的阳性环周切缘及其对辅助治疗的影响。

Defining a positive circumferential resection margin in oesophageal cancer and its implications for adjuvant treatment.

机构信息

Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.

出版信息

Br J Surg. 2013 Jul;100(8):1055-63. doi: 10.1002/bjs.9145. Epub 2013 Apr 24.

DOI:10.1002/bjs.9145

PMID:23616367

Abstract

BACKGROUND

A positive circumferential resection margin (CRM) has been associated with a poorer prognosis in oesophageal and oesophagogastric junctional (OGJ) cancer. The College of American Pathologists defines the CRM as positive if tumour cells are present at the margin, whereas the Royal College of Pathologists also include tumour cells within 1 mm of this margin. The relevance of these differences is not clear and no study has investigated the impact of adjuvant therapy. The aim was to identify the optimal definition of an involved CRM in patients undergoing resection for oesophageal or OGJ cancer, and to determine whether adjuvant radiotherapy improved survival in patients with an involved CRM.

METHODS

This was a single-centre retrospective study of patients who had undergone attempted curative resection for a pathological T3 oesophageal or OGJ cancer. Clinicopathological variables and distance from the tumour to the CRM, measured to ± 0.1 mm, were correlated with survival.

RESULTS

A total of 226 patients were included. Sex (P = 0·018), tumour differentiation (P = 0·019), lymph node status (P < 0·001), number of positive nodes (P < 0·001), and CRM distance (P = 0·042) were independently predictive of prognosis. No significant survival difference was observed between positive CRM 0-mm and 0·1-0·9-mm groups after controlling for other prognostic variables. Both groups had poorer survival than matched patients with a CRM at least 1 mm clear of tumour cells. Among patients with a positive CRM of less than 1 mm, those undergoing observation alone had a median survival of 18·6 months, whereas survival was a median of 10 months longer in patients undergoing adjuvant radiotherapy, but otherwise matched for prognostic variables (P = 0·009).

CONCLUSION

A positive CRM of 1 mm or less should be regarded as involved. Adjuvant radiotherapy confers a significant survival benefit in selected patients with an involved CRM.

摘要

背景

在食管和食管胃交界部（OGJ）癌症中，阳性环周切缘（CRM）与预后较差相关。美国病理学家学院将 CRM 定义为阳性，如果肿瘤细胞存在于切缘处，而皇家病理学院还包括距离该切缘 1 毫米以内的肿瘤细胞。这些差异的相关性尚不清楚，也没有研究调查辅助治疗的影响。目的是确定在接受食管或 OGJ 癌切除术的患者中，涉及 CRM 的最佳定义，并确定涉及 CRM 的患者接受辅助放疗是否能提高生存率。

方法

这是一项单中心回顾性研究，纳入了接受病理性 T3 食管或 OGJ 癌根治性切除术的患者。对临床病理变量和肿瘤至 CRM 的距离（精确到 ± 0.1 毫米）进行了相关性分析，并与生存情况相关联。

结果

共纳入 226 例患者。性别（P = 0.018）、肿瘤分化（P = 0.019）、淋巴结状态（P < 0.001）、阳性淋巴结数量（P < 0.001）和 CRM 距离（P = 0.042）是独立的预后预测因素。在控制其他预后因素后，CRM 为 0 毫米和 0.1-0.9 毫米的阳性组之间的生存差异无统计学意义。与 CRM 距离至少 1 毫米清除肿瘤细胞的匹配患者相比，这两组的生存均较差。在 CRM 阳性小于 1 毫米的患者中，仅观察的患者中位生存期为 18.6 个月，而接受辅助放疗的患者中位生存期延长了 10 个月，但其他预后变量匹配（P = 0.009）。