Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Pathology, Rigshospital, University of Copenhagen, Copenhagen, Denmark.
Colorectal Dis. 2022 Feb;24(2):197-209. doi: 10.1111/codi.15971. Epub 2021 Nov 17.
Microscopically positive (R1) margins are associated with poorer outcomes in patients with colorectal cancer. However, little is known of the differential impact of subdivisions of R1 margins, be they to the primary tumour (R1tumour) or to lymph node metastases/tumour deposits (R1LNM).
Patients treated for Stage III colorectal cancer from 1 January 2016 to 31 December 2019 were identified from the Danish national cancer registry. Patients were stratified into three groups according to margin status (R0 vs. R1tumour vs. R1LNM). The primary outcome was overall survival.
In all, 4186 patients were included, comprising 3012 patients with colon cancer and 1174 patients with rectal cancer. The R1 resection rates were 16.5% and 18.2% in patients with colon and rectum cancer, respectively. In colon cancers, 3-year overall survival was reduced in patients with R1LNM (65.7%, 95% CI 62.8-68.6) or R1tumour margins (51.8%, 95% CI 47.3-56.3) compared with R0 resections (80.8%, 95% CI 79.9-81.6, P < 0.001). A similar impact on survival was seen in rectal cancers (R0, 84.2%, 95% CI 82.9-85.5; R1LNM, 72.2%, 95% CI 67.8-76.6; R1tumour, 56.6%, 95% CI 50.0-63.2, P < 0.001). Margin status was independently prognostic of survival in both colon (R1tumour, hazard ratio 2.08, 95% CI 1.50-2.89, P < 0.001; R1LNM, hazard ratio 1.48, 95% CI 1.11-1.97, P = 0.008) and rectal cancers (R1tumour, hazard ratio 2.35, 95% CI 1.42-3.90, P < 0.001; R1LNM, hazard ratio 1.54, 95% CI 0.95-2.48, P = 0.077).
R1 subdivisions have distinct impacts on survival in Stage III colorectal cancer. Further focused research in these patient subgroups is warranted.
显微镜下阳性（R1）切缘与结直肠癌患者的预后较差有关。然而，对于 R1 切缘的细分（无论是原发肿瘤[R1 肿瘤]还是淋巴结转移/肿瘤沉积[R1LNM]）的差异影响知之甚少。
从丹麦国家癌症登记处确定了 2016 年 1 月 1 日至 2019 年 12 月 31 日期间接受 III 期结直肠癌治疗的患者。根据切缘状态（R0 与 R1 肿瘤与 R1LNM）将患者分为三组。主要结局是总生存。
共纳入 4186 例患者，其中结肠直肠癌 3012 例，直肠 1174 例。结肠癌和直肠癌的 R1 切除率分别为 16.5%和 18.2%。在结肠癌中，与 R0 切除相比，R1LNM（65.7%，95%CI 62.8-68.6）或 R1 肿瘤边缘（51.8%，95%CI 47.3-56.3）的患者 3 年总生存率降低（80.8%，95%CI 79.9-81.6，P<0.001）。在直肠癌中也观察到类似的生存影响（R0，84.2%，95%CI 82.9-85.5；R1LNM，72.2%，95%CI 67.8-66.6；R1 肿瘤，56.6%，95%CI 50.0-63.2，P<0.001）。在结肠癌（R1 肿瘤，风险比 2.08，95%CI 1.50-2.89，P<0.001；R1LNM，风险比 1.48，95%CI 1.11-1.97，P=0.008）和直肠癌（R1 肿瘤，风险比 2.35，95%CI 1.42-3.90，P<0.001；R1LNM，风险比 1.54，95%CI 0.95-2.48，P=0.077）中，切缘状态均为独立的生存预后因素。
R1 细分对 III 期结直肠癌的生存有明显影响。需要对这些患者亚组进行进一步的重点研究。
