Lee Geun Dong, Lee Seung Eun, Kim Kyoung-Mee, Kim Yong-Hee, Ahn Joong Hyun, Jung Sinho, Choi Yoon-La, Kim Hyeong Ryul, Park Seung-Il, Shim Young Mog
*Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,Republic of Korea †Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea ‡Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul,Republic of Korea and Department of Biostatistics and Bioinformatics, Duke University, Durham, NC §Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Ann Surg. 2015 Dec;262(6):965-71. doi: 10.1097/SLA.0000000000001039.
We aimed to investigate the optimal cutoff value of circumferential resection margin (CRM) of esophageal squamous cell carcinoma (ESCC) in patients who underwent radical esophagectomy.
Tumor involvement of a CRM in ESCC has not been clearly defined.
We reviewed 479 pT3 ESCC patients to find the optimal cutoff point of distance from CRM in addition to 0 μm for discriminating survival time.
The partitions at and near the 500 μm distance from CRM generated the largest log-rank statistics (P = 0.0086). Therefore, we added 500 μm as an additional cutoff value for a positive CRM. Compared to patients with CRM greater than 500 μm, patients with CRM 0 μm showed worse overall survival (P < 0.001) and progression-free survival (P < 0.001), followed by patients with 0 to 500 μm (P = 0.008 and 0.066, respectively). In multivariable analyses, overall survival differences remained significant [0 < CRM ≤ 500 μm vs CRM > 500 μm, hazards ratio (HR) = 1.875, 97.5% CI: 1.243-2.829, P = 0.002; CRM = 0 μm vs CRM > 500 μm, HR = 2.666, 97.5% CI: 1.745-4.076, P < 0.001]. In comparison of criteria from the College of American Pathologists, the Royal College of Pathologists, and this study, HRs of positive CRM (95% CI, P-value) were 1.969 (1.501-2.584, P < 0.001), 1.384 (1.039-1.844, P = 0.027), and 1.696 (1.342-2.143, P < 0.001), respectively.
In patients with ESCC, we developed new, 3-tiered CRM criteria providing more detailed prognostic information than the 2-tiered criteria.
我们旨在研究接受根治性食管切除术的食管鳞状细胞癌（ESCC）患者环周切缘（CRM）的最佳截断值。
ESCC中CRM的肿瘤累及情况尚未明确界定。
我们回顾了479例pT3期ESCC患者，以寻找除0μm外距离CRM的最佳截断点，用于区分生存时间。
距离CRM 500μm处及附近的划分产生了最大的对数秩统计量（P = 0.0086）。因此，我们将500μm作为CRM阳性的额外截断值。与CRM大于500μm的患者相比，CRM为0μm的患者总生存期（P < 0.001）和无进展生存期（P < 0.001）更差，其次是CRM为0至500μm的患者（分别为P = 0.008和0.066）。在多变量分析中，总生存期差异仍然显著[0 < CRM≤500μm与CRM > 500μm，风险比（HR）= 1.875，97.5%置信区间：1.243 - 2.829，P = 0.002；CRM = 0μm与CRM > 500μm，HR = 2.666，97.5%置信区间：1.745 - 4.076，P < 0.001]。与美国病理学家学会、皇家病理学家学会的标准以及本研究的标准相比，CRM阳性的HR（95%置信区间，P值）分别为1.969（1.501 - 2.584，P < 0.001）、1.384（1.039 - 1.844，P = 0.027）和1.696（1.342 - 2.143，P < 0.001）。
在ESCC患者中，我们制定了新的三层CRM标准，比两层标准提供了更详细的预后信息。
