From the Department of Pathology (Drs Setoodeh and Gopal) and the Division of Digestive and Liver Diseases (Drs Singal and Ahmed), UT Southwestern Medical Center, Dallas, Texas; the Department of Pathology, Mercy Medical Center, Baltimore, Maryland (Dr Liu); the Department of Pathology, University of Iowa Healthcare, Iowa City (Dr Boukhar); the Department of Pathology (Dr Westerhoff) and the Division of Gastroenterology and Hepatology (Dr Waljee), University of Michigan Health System, Ann Arbor; and VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan (Dr Waljee).
Arch Pathol Lab Med. 2019 Apr;143(4):505-509. doi: 10.5858/arpa.2018-0011-OA. Epub 2018 Nov 16.
CONTEXT.—: Conflicting data about the clinical significance of microscopic Crohn disease (CD) activity at resection margins have led to varying practice patterns for routine reporting by pathologists.
OBJECTIVE.—: To characterize the association between active disease at resection margins with postoperative CD recurrence and time-to-recurrence in the era of anti-tumor necrosis factor therapy.
DESIGN.—: We performed a multicenter retrospective cohort study of 101 consecutive CD bowel resections during 10 years. Margin slides were reviewed, and CD activity at the margins was graded as none, mild, moderate, or severe. The association between microscopic CD activity at the margin with postoperative recurrence and time-to-recurrence were evaluated with logistic regression and Cox regression analyses, respectively.
RESULTS.—: Crohn disease activity at resection margins was reported in 43% of pathology reports. Resection margins had CD involvement in 39.6% of cases, 20 of which were classified as mild, 6 as moderate, and 12 with severe CD activity. Although patients with mild (odds ratio, 1.14; 95% CI, 0.40-3.20) and moderate to severe (odds ratio, 1.97; 95% CI, 0.62-6.35) activity were at increased risk of disease recurrence, the differences were not statistically significant. Patients with mild (hazard ratio, 0.97; 95% CI, 0.50-1.91) and moderate to severe (hazard ratio, 1.29; 95% CI, 0.65-2.55) disease activity at margins did not have significantly different time-to-recurrence compared with those without disease activity.
CONCLUSIONS.—: Our study suggests CD activity at resection margins is not significantly associated with postoperative CD recurrence.
切除边缘处存在显微镜下克罗恩病（CD）活动的临床意义存在矛盾，这导致病理学家在常规报告中存在不同的实践模式。
在使用肿瘤坏死因子治疗的时代，研究切除边缘处存在活动期疾病与术后 CD 复发和复发时间之间的关系。
我们对 10 年内进行的 101 例连续 CD 肠切除术进行了多中心回顾性队列研究。对边缘切片进行了回顾，并将边缘处的 CD 活动度评为无、轻度、中度或重度。使用逻辑回归和 Cox 回归分析分别评估边缘处显微镜下 CD 活动与术后复发和复发时间之间的关系。
43%的病理学报告报告了切除边缘的 CD 活动。39.6%的病例边缘存在 CD 受累，其中 20 例为轻度，6 例为中度，12 例为重度 CD 活动。尽管轻度（比值比，1.14；95%置信区间，0.40-3.20）和中重度（比值比，1.97；95%置信区间，0.62-6.35）活动的患者疾病复发的风险增加，但差异无统计学意义。边缘处有轻度（风险比，0.97；95%置信区间，0.50-1.91）和中重度（风险比，1.29；95%置信区间，0.65-2.55）疾病活动的患者与无疾病活动的患者相比，复发时间无显著差异。
我们的研究表明，切除边缘处的 CD 活动与术后 CD 复发无显著相关性。
