Elshaer Ahmed M, Jones Sian, Cockbain Andrew J, Dexter Simon P L, Grabsch Heike I, Mehta Samir P, Sarela Abeezar, West Nicholas P, Hayden Jeremy D
Department of Upper Gastrointestinal Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Cairo University Hospitals (Kasr-Alainy Hospital), Cairo, Egypt.
Department of Upper Gastrointestinal Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Eur J Surg Oncol. 2025 Aug;51(8):110138. doi: 10.1016/j.ejso.2025.110138. Epub 2025 May 9.
The definition of the circumferential resection margin (CRM) involvement for esophageal cancer varies between the Royal College of Pathologists (RCP) and College of American Pathologists (CAP). There are insufficient data regarding the prognostic relevance of different sites of involvement at the CRM. In this study, we examined the prognostic impacts of different CRM definitions and different radial margin locations.
This retrospective study included 449 patients who were treated by curative esophagectomy for esophageal or junctional cancers between 2010 and 2021. The distance of the closest tumour cells to the inked CRM was examined and site of CRM involvement was recorded. Patients with an involved longitudinal resection margin were excluded. Long-term follow up data were obtained from the hospital's electronic health records.
Tumour cells at or within 1 mm from the CRM (CRM-RCP R1≤1 mm) was observed in 196 patients (43.7 %). CRM(≤1 mm) was associated with poorer overall survival (OS) and disease-free survival (DFS) compared to CRM-R0, p-values <0.001 for both. Tumour cells at the CRM (CRM-CAP R1-0 mm) was observed in 61 patients (13.6 %). Patients with CRM-0mm had poorer OS and DFS compared to CRM≤1 mm, p-values 0.039 and 0.013 respectively. Presence of tumour cells (CRM≤1 mm) at multiple locations of the CRM was related to poorer survival compared to a single location; (OS p-value 0.008, DFS p-value 0.05). The posterior margin was the most common positive single CRM-positive site (44 %), followed by anterior (39 %) and lateral sites (17 %). However, the anterior margins carried poorer OS and DFS compared to posterior and lateral sites, (p-values 0.37 and 0.39 respectively).
This study demonstrated that CRM involvement as defined by RCP was an independent prognostic factor for both survival and recurrence in esophageal cancer. It promoted the value of additional reporting CRM-0mm in CRM-R1 cases. The study also investigated the relative importance of reporting CRM-R1 location, which might be a useful prognostic tool in the future.
皇家病理学家学院（RCP）和美国病理学家学会（CAP）对食管癌环周切缘（CRM）受累的定义有所不同。关于CRM不同受累部位的预后相关性的数据不足。在本研究中，我们研究了不同CRM定义和不同径向切缘位置的预后影响。
这项回顾性研究纳入了2010年至2021年间接受食管癌或交界癌根治性食管切除术治疗的449例患者。检查最接近肿瘤细胞到标记的CRM的距离，并记录CRM受累部位。排除纵向切缘受累的患者。长期随访数据来自医院的电子健康记录。
196例患者（43.7%）观察到肿瘤细胞位于CRM处或距CRM 1mm以内（CRM-RCP R1≤1mm）。与CRM-R0相比，CRM（≤1mm）与较差的总生存期（OS）和无病生存期（DFS）相关，两者的p值均<0.001。61例患者（13.6%）观察到CRM处有肿瘤细胞（CRM-CAP R1-0mm）。与CRM≤1mm相比，CRM-0mm患者的OS和DFS较差，p值分别为0.039和0.013。与单个部位相比，CRM多个部位存在肿瘤细胞（CRM≤1mm）与较差的生存率相关；（OS p值0.008，DFS p值0.05）。后缘是最常见的单个CRM阳性部位（44%），其次是前缘（39%）和侧缘部位（17%）。然而，与后缘和侧缘部位相比，前缘的OS和DFS较差，（p值分别为0.37和0.39）。
本研究表明，RCP定义的CRM受累是食管癌生存和复发的独立预后因素。它提升了在CRM-R1病例中额外报告CRM-0mm的价值。该研究还调查了报告CRM-R1位置的相对重要性，这可能是未来一种有用的预后工具。
