Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Pathology, Rigshospital, University of Copenhagen, Copenhagen, Denmark.
Colorectal Dis. 2022 Jul;24(7):828-837. doi: 10.1111/codi.16121. Epub 2022 Mar 31.
Microscopically positive (R1) margins are associated with poorer outcomes in patients with colorectal cancer. However, the impact of subdivisions of R1 margins, be they to the primary tumour (R1 tumour) or to lymph node metastases (R1LNM), on patterns of relapse is unknown.
Patients treated for stage III colorectal cancer from 01 January 2016 to 31 December 2019 in four specialist centres were identified from the Danish national cancer registry. Patients were stratified into three groups according to margin status (R0 vs. R1 tumour vs. R1LNM). The primary outcomes were local recurrence-free survival (LRFS), distant metastases-free survival (DMFS) and disease-specific survival (DSS).
A total of 1,164 patients were included, with R1 margins found in 237 (20.4%). Irrespective of tumour location, R1 tumour and R1LNM margins were independent prognostic factors for systemic relapse (R1 tumour HR 1.84, CI: 1.17-2.88, p = 0.008; R1LNM HR 1.59, CI: 1.12-2.27, p = 0.009) and disease-related death (R1 tumour HR 2.08, CI: 1.12-3.85, p = 0.020; R1LNM HR 1.84, CI: 1.12-3.02, p = 0.016). Whereas R1 tumour margins were associated with poorer 3-year LRFS in both colon and rectum cancer, R1LNM margins only reduced LRFS in patients with rectal cancer. Patterns of relapse differed between R1 subdivisions, with R1 tumour margins more likely to affect multiple anatomical sites, with a predilection for extra-hepatic/pulmonary metastases.
Subdivisions of R1 margins have a distinct impact on the oncological outcomes and patterns of disease relapse in patients with stage III colorectal cancer.
显微镜下阳性（R1）切缘与结直肠癌患者的预后较差相关。然而，R1 切缘的细分，无论是针对原发肿瘤（R1 肿瘤）还是淋巴结转移（R1LNM），对复发模式的影响尚不清楚。
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 日在四个专业中心接受 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。主要结局是局部无复发生存（LRFS）、远处无转移生存（DMFS）和疾病特异性生存（DSS）。
共纳入 1164 例患者，其中 237 例（20.4%）存在 R1 切缘。无论肿瘤位置如何，R1 肿瘤和 R1LNM 切缘均是全身复发的独立预后因素（R1 肿瘤 HR 1.84，CI：1.17-2.88，p=0.008；R1LNM HR 1.59，CI：1.12-2.27，p=0.009）和疾病相关死亡（R1 肿瘤 HR 2.08，CI：1.12-3.85，p=0.020；R1LNM HR 1.84，CI：1.12-3.02，p=0.016）。虽然 R1 肿瘤切缘与结直肠癌和直肠癌患者的 3 年 LRFS 较差相关，但 R1LNM 切缘仅降低直肠癌患者的 LRFS。复发模式在 R1 细分之间存在差异，R1 肿瘤切缘更可能影响多个解剖部位，偏爱肝外/肺转移。
R1 切缘的细分对 III 期结直肠癌患者的肿瘤学结局和疾病复发模式有明显影响。
