Hulshoff J B, Faiz Z, Karrenbeld A, Kats-Ugurlu G, Burgerhof J G M, Smit J K, Plukker J Th M
Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, 9713 AV, Groningen, The Netherlands.
Department of Pathology, University of Groningen, University Medical Center Groningen, 9713 AV, Groningen, The Netherlands.
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S1301-9. doi: 10.1245/s10434-015-4827-2. Epub 2015 Aug 28.
Circumferential resection margins (CRM) for esophageal cancer (EC), defined by the College of American Pathologists (CAP; >0 mm) or the Royal College of Pathologists (RCP; >1 mm) as tumor-free (R0), are based on a surgery-alone approach. We evaluated the usefulness of both definitions in current practice with neoadjuvant chemoradiotherapy (nCRT).
CRMs were measured in 209 patients (104 with nCRT) with locally advanced EC after transthoracic esophagectomy. Local recurrence and cancer related death were scored as events. Patients were followed for at least 2 years or until death. Prognostic factors (P < 0.1 in univariate analyses) for 2-year disease-free survival (DFS) and local recurrence-free survival (LRFS) were incorporated in multivariate Cox regression analyses. Both CRM measurements were analyzed separately and prognostic cutoff values (0-1.0 mm) were assessed in both groups.
Independent prognostic factors (P < 0.05) for 2-year DFS were tumor length, lymph node ratio, angioinvasion, and CAP R0 in the surgery-alone group and pN stage (P < 0.01) in the nCRT group. Prognostic factors (P < 0.05) for 2-year LRFS were CAP, lymph node ratio, and tumor length in the surgery-alone group, and CAP and grade in the nCRT group. Optimal CRM cutoff values between 0.0 and 0.2 mm were prognostic for 2-year DFS in the surgery-alone and at 0.3 mm for the nCRT group.
nCRT affected the CRM cutoff values. After nCRT, the CRM R0 according to the CAP was only prognostic for 2-year LRFS. However, in the surgery-alone group, it was prognostic for both the 2-year DFS and LRFS.
美国病理学家学会（CAP；>0 mm）或皇家病理学家学会（RCP；>1 mm）将食管癌（EC）的环周切缘（CRM）定义为无肿瘤（R0），这是基于单纯手术方法。我们评估了这两种定义在当前新辅助放化疗（nCRT）实践中的实用性。
对209例局部晚期EC患者（104例接受nCRT）行胸段食管切除术后测量CRM。将局部复发和癌症相关死亡计为事件。对患者随访至少2年或直至死亡。将单因素分析中2年无病生存率（DFS）和无局部复发生存率（LRFS）的预后因素（P<0.1）纳入多因素Cox回归分析。分别分析两种CRM测量值，并评估两组的预后临界值（0 - 1.0 mm）。
单纯手术组2年DFS的独立预后因素（P<0.05）为肿瘤长度、淋巴结比率、血管侵犯和CAP R0，nCRT组为pN分期（P<0.01）。单纯手术组2年LRFS的预后因素（P<0.05）为CAP、淋巴结比率和肿瘤长度，nCRT组为CAP和分级。0.0至0.2 mm之间的最佳CRM临界值对单纯手术组的2年DFS具有预后意义，对nCRT组为0.3 mm。
nCRT影响CRM临界值。nCRT后，根据CAP的CRM R0仅对2年LRFS具有预后意义。然而，在单纯手术组中，它对2年DFS和LRFS均具有预后意义。
