Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Thoracic Surgery, Department of Surgery, Koo-Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, ROC; Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.
J Chin Med Assoc. 2013 Oct;76(10):570-5. doi: 10.1016/j.jcma.2013.07.001. Epub 2013 Aug 12.
Despite the significant advances in surgical techniques and multimodality treatments for esophageal cancer, the overall survival remains unsatisfactory. During the past years, efforts were made to determine the prognostic factors that would help in identifying patients suitable for surgery or guiding adjuvant therapy. Positive circumferential resection margins (CRMs) in esophageal cancer have been previously linked with poor prognosis, but their impact on survival remains controversial in patients treated by a multimodality protocol. The aim of our study was to examine the significance of tumor involvement of CRM in patients with esophageal squamous cell carcinoma after concurrent chemoradiation therapy followed by esophagectomy.
Between 2000 and 2010, 94 esophageal squamous cell carcinoma patients who received preoperative concurrent chemoradiation therapy followed by surgery were enrolled in our study. We focused on the CRM, which was defined microscopically as clear (negative) or involved (positive). Univariate and multivariate survival analyses were performed with overall survival as the endpoint.
Our cohort was predominantly male (94.7%) with a median age of 57 years. All of them received concurrent chemoradiation therapy followed by esophagectomy. Overall, 17 patients (18.1%) had positive CRM. Kaplan-Meier survival analysis demonstrated that the 5-year overall survival of patients with clear and involved CRM is 60.1% and 11.8%, respectively (log rank p < 0.001). Multivariate analysis with the Cox proportional hazard model demonstrated that CRM involvement is a significant prognostic factor for overall survival (p < 0.001).
In patients with esophageal squamous cell carcinoma who underwent trimodality treatment, CRM involvement is a significant risk factor predicting survival. Additional effort is required to achieve a clear CRM in esophageal cancer treatment.
尽管在外科技术和多模式治疗食管癌方面取得了重大进展，但总体生存率仍不尽如人意。在过去的几年中，人们努力确定有助于识别适合手术或指导辅助治疗的患者的预后因素。食管癌阳性环周切缘（CRM）先前与预后不良相关，但在接受多模式方案治疗的患者中，其对生存的影响仍存在争议。我们的研究目的是检查在接受同步放化疗后行手术治疗的食管鳞癌患者中 CRM 肿瘤侵犯对生存的意义。
2000 年至 2010 年，我们共纳入 94 例接受术前同步放化疗后手术的食管鳞癌患者。我们重点关注 CRM，CRM 在显微镜下定义为阴性（clear）或阳性（involved）。采用单因素和多因素生存分析，以总生存为终点。
我们的队列主要为男性（94.7%），中位年龄为 57 岁。所有患者均接受同步放化疗后行手术治疗。总体而言，17 例（18.1%）患者的 CRM 阳性。Kaplan-Meier 生存分析显示，CRM 阴性和阳性患者的 5 年总生存率分别为 60.1%和 11.8%（对数秩检验 p < 0.001）。Cox 比例风险模型的多因素分析表明，CRM 侵犯是总生存的显著预后因素（p < 0.001）。
在接受三联治疗的食管鳞癌患者中，CRM 侵犯是预测生存的重要危险因素。需要进一步努力以实现食管癌治疗中的 CRM 清晰。
