Haneda Ryoma, Kikuchi Hirotoshi, Nagakura Yuka, Notsu Akifumi, Booka Eisuke, Murakami Tomohiro, Matsumoto Tomohiro, Mayanagi Shuhei, Morita Yoshifumi, Hiramatsu Yoshihiro, Tsubosa Yasuhiro, Takeuchi Hiroya
Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Ann Surg Oncol. 2022 Mar 2. doi: 10.1245/s10434-022-11491-7.
The clinical significance of circumferential resection margin (CRM) in esophageal squamous cell carcinoma (ESCC) remains unclear. Optimal CRM for predicting the recurrence of pathological T3 ESCC was investigated.
Seventy-three patients were retrospectively investigated in the development cohort. Patients were divided into CRM-negative and CRM-positive groups, and clinicopathological factors and survival outcomes were compared between the groups. The cutoff value was validated in another validation cohort (n = 99).
Receiver operating characteristic analysis in the development cohort showed the cutoff value of CRM was 600 μm. In the validation cohort, patients in the CRM-positive group showed a significantly higher rate of locoregional recurrence (p = 0.006) and worse recurrence-free survival (RFS) (p < 0.001) than those in the CRM-negative group. Multivariate analysis identified positive CRM as an independent predictive factor for poor RFS (hazard ratio, 2.695; 95% confidence interval, 1.492-4.867; p = 0.001). The predictive value of our criteria of positive CRM for RFS was higher than that of the Royal College of Pathologists (RCP) and the College of American Pathologists (CAP) criteria. Stratified analysis in the neoadjuvant chemotherapy groups also revealed that the rate of locoregional recurrence was higher in the CRM-positive group than in the CRM-negative group both in the pathological N0 and N1-3 subgroups.
CRM of 600 μm can be the optimal cutoff value rather than the RCP and CAP criteria for predicting locoregional recurrence after esophagectomy. These results may support the impact of perioperative locoregional control of locally advanced ESCC.
食管鳞状细胞癌（ESCC）中环周切缘（CRM）的临床意义仍不明确。本研究旨在探讨预测病理T3期ESCC复发的最佳CRM。
对73例患者进行回顾性研究作为开发队列。将患者分为CRM阴性和CRM阳性组，比较两组的临床病理因素和生存结果。在另一个验证队列（n = 99）中验证截断值。
开发队列中的受试者工作特征分析显示CRM的截断值为600μm。在验证队列中，CRM阳性组患者的局部区域复发率显著高于CRM阴性组（p = 0.006），无复发生存期（RFS）更差（p < 0.001）。多因素分析确定CRM阳性是RFS不良的独立预测因素（风险比，2.695；95%置信区间，1.492 - 4.867；p = 0.001）。我们的CRM阳性标准对RFS的预测价值高于皇家病理学家学院（RCP）和美国病理学家学院（CAP）的标准。新辅助化疗组的分层分析还显示，在病理N0和N1 - 3亚组中，CRM阳性组的局部区域复发率均高于CRM阴性组。
600μm的CRM可作为预测食管切除术后局部区域复发的最佳截断值，而非RCP和CAP标准。这些结果可能支持局部晚期ESCC围手术期局部区域控制的影响。
