Impact of Circumferential Resection Margin Distance on Locoregional Recurrence and Survival after Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

Chao, Yin‐Kai; Yeh, Chi-Ju; Chang, Hsien‐Kun; Tseng, Chen‐Kan; Chu, Yin-Yi; Hsieh, Ming‐Ju; Wu, Yi‐Cheng; Liu, Huiping

doi:10.1245/s10434-010-1244-4

Cited by 43 publications

(53 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with the reported literature, CRM invasion did contribute to shorter survival in ESCC patients, either in surgery group or in nCCRT-surgery group (Tables 3,4) (18,30,31). When divided into sub-groups I, II and III (≤3, 3-5, >5 cm), the CRM invasion rates in surgery group raised from 3.2% to 4.5% and then 31.3% progressively, however, they remained around 10% in nCCRT-surgery group (Table 5).…”

Section: Discussionsupporting

confidence: 89%

Prognostic role of initial pan-endoscopic tumor length at diagnosis in operable esophageal squamous cell carcinoma undergoing esophagectomy with or without neoadjuvant concurrent chemoradiotherapy

Lin¹,

Liu²,

Cheng³

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

Background: The objective of this study was to appraise the prognostic role of initial pan-endoscopic tumor length at diagnosis within or between operable esophageal squamous cell carcinoma (ESCC) undergoing upfront esophagectomy or neoadjuvant concurrent chemoradiotherapy (nCCRT) followed by esophagectomy.Methods: Between Jan 2001 and Dec 2013 in Koo-Foundation Sun Yat-sen Cancer Center in Taiwan, 101 ESCC patients who underwent upfront esophagectomy (surgery group) and 128 nCCRT followed by esophagectomy (nCCRT-surgery group) were retrospectively collected. Prognostic variables, including initial pan-endoscopic tumor length at diagnosis (sub-grouped ≤3, 3-5 and >5 cm), status of circumferential resection margin (CRM), and pathological T/N/M-status and cancer stage, were appraised within or between surgery and nCCRT-surgery groups.Results: Within surgery group, longer initial pan-endoscopic tumor length at diagnosis (≤3, 3-5 and >5 cm; HR =1.000, 1.688 and 4.165; P=0.007) was an independent prognostic factor that correlated with advanced T/N/M-status, late cancer stage, and CRM invasion (all's P<0.001). Based on the initial panendoscopic tumor length at diagnosis ≤3, 3-5 and >5 cm, nCCRT-surgery group had a poorer (P=0.039), similar (P=0.447) and better (P<0.001) survivals than did surgery group, respectively. For those with initial pan-endoscopic tumor length at diagnosis >5 cm, nCCRT-surgery group had more percentage of T0/N0-status and stage 0 (all's P<0.05), and fewer rate of CRM invasion (P=0.036) than did surgery group.Conclusions: Initial pan-endoscopic tumor length at diagnosis could be a criterion to select proper ESCC cases for nCCRT followed by esophagectomy to improve survival and reduce CRM invasion.

show abstract

Section: Discussionsupporting

confidence: 89%

Prognostic role of initial pan-endoscopic tumor length at diagnosis in operable esophageal squamous cell carcinoma undergoing esophagectomy with or without neoadjuvant concurrent chemoradiotherapy

Lin¹,

Liu²,

Cheng³

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…These results were later proven by other studies, which also identified a prognostic role of a positive CRM on recurrences [3,13,14,17,18,22,26]. Chao et al [26] found a significant influence of an involved CRM not only on loco-regional but also on distant recurrences, while an involvement to the CRM of less than 1 mm was associated with early loco-regional recurrences. In another study, involvement of the CRM was only associated to recurrences, being outside the lymphatic drainage of the esophagus and the gastroesophageal junction [17].…”

Section: Recurrencementioning

confidence: 70%

“…In the first study of CRM involvement by Sagar et al [25], significantly (p < 0.01) more patients with a positive CRM (55%) developed a local recurrence as compared to those without involvement of the CRM (13%) [25]. These results were later proven by other studies, which also identified a prognostic role of a positive CRM on recurrences [3,13,14,17,18,22,26]. Chao et al [26] found a significant influence of an involved CRM not only on loco-regional but also on distant recurrences, while an involvement to the CRM of less than 1 mm was associated with early loco-regional recurrences.…”

Section: Recurrencementioning

confidence: 87%

Does the Margin Matter in Esophageal Cancer

Karstens

Izbicki²,

Reeh³

2017

Dig Surg

View full text Add to dashboard Cite

Background: The prognostic impact of circumferential resection margin (CRM) involvement in resected esophageal cancer (EC) is controversial discussed. The College of American Pathologists (CAP) and the Royal College of Pathologists (RCP) provide 2 different definitions of CRM involvement. The aim of this systematic review was to evaluate the clinical significance of CRM involvement on patients' survival following esophagectomy due to EC. Methods: PubMed, Science Direct, and Google scholar were searched for studies analyzing the clinical impact of CRM in EC. Summary: A total of 28 studies analyzed the prognostic effect of a positive CRM in EC. A wide range of CRM involvement (8.6-83.1%) was reported. Both available meta-analyses found a significant association between a positive CRM and patients' survival irrespective of RCP (OR 2.52 [95% CI 1.96-3.25; p < 0.001]) or CAP (OR 4.02 [95% CI 2.25-7.20; p < 0.001]) criteria. The influence of neoadjuvant therapy on the CRM remains unclear. Key Messages: CRM involvement is a useful parameter for EC patients' prognosis. The application of CAP criteria should be preferred since patients with a poor prognosis can be identified more sufficiently. Neoadjuvant therapy and en bloc transthoracic esophagectomy show favorable results for achievement of negative CRM.

show abstract

“…Some studies6 9, 16 20, 30 have examined the effect of CAP and RCP on rates and patterns of recurrence. A multicentre study9 (using the CAP definition of CRM positivity) found a significant increase in local recurrence rates between CRM‐positive and ‐negative patients (41·2 per cent versus 26·2 per cent respectively; P < 0·001) after propensity score matching, but no difference in systemic recurrence rates (28·3 versus 28·9 per cent; P = 0·664).…”

Section: Discussionmentioning

confidence: 99%

“…The College of American Pathologists (CAP) defines a positive CRM as tumour at the cut margin (TAM), which has been advocated in some studies4, 5, 6, 7, 8, 9, whereas the Royal College of Pathologists (RCP) defines a positive CRM as tumour within 1 mm, preferred in other studies10, 11, 12, 13. Some studies have found the CRM to be independently prognostically significant4 7, 9 10, 13, 14, 15, 16, and others have not5 6, 11 12, 17, 18, 19. A positive margin may increase the likelihood of locoregional and systemic tumour recurrence9 20, although it is unclear whether the latter is simply a reflection of a larger, more advanced tumour.…”

Section: Introductionmentioning

confidence: 99%

Impact of incremental circumferential resection margin distance on overall survival and recurrence in oesophageal adenocarcinoma

Knight

Zylstra²,

Wulaningsih

et al. 2018

BJS Open

View full text Add to dashboard Cite

BackgroundPrevious analyses of the oesophageal circumferential resection margin (CRM) have focused on the prognostic validity of two different definitions of a positive CRM, that of the College of American Pathologists (tumour at margin) and that of the Royal College of Pathologists (tumour within 1 mm). This study aimed to analyse the validity of these definitions and explore the risk of recurrence and survival with incremental tumour distances from the CRM.MethodsThis cohort study included patients who underwent resection for adenocarcinoma of the oesophagus between 2000 and 2014. Kaplan–Meier and Cox regression analyses were performed to determine the hazard ratio (HR) with 95 per cent confidence intervals for recurrence and mortality in CRM increments: tumour at the cut margin, extending to within 0·1–0·9, 1·0–1·9, 2·0–4·9 mm, and 5·0 mm or more from the margin.ResultsA total of 444 patients were included in the study. Kaplan–Meier and unadjusted analyses showed a significant incremental improvement in overall survival (P < 0·001) and recurrence (P for trend < 0·001) rates with increasing distance from the CRM. Tumour distance of 2·0 mm or more remained a significant predictor of survival on multivariable analysis (HR for risk of death 0·66, 95 per cent c.i. 0·44 to 1·00). Multivariable analysis of overall survival demonstrated a significant difference between a positive and negative CRM with the Royal College of Pathologists' definition (HR 1·37, 1·01 to 1·85), but not with the College of American Pathologists' definition (HR 1·22, 0·90 to 1·65).ConclusionThis study demonstrated an incremental improvement in survival and recurrence rates with increasing tumour distance from the CRM.

show abstract

Impact of Circumferential Resection Margin Distance on Locoregional Recurrence and Survival after Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

Abstract: In ypT3 esophageal SCC patients, CRM distance provides useful information for risk stratification in cancer recurrence and survival.

Cited by 43 publications

References 18 publications

Prognostic role of initial pan-endoscopic tumor length at diagnosis in operable esophageal squamous cell carcinoma undergoing esophagectomy with or without neoadjuvant concurrent chemoradiotherapy

Prognostic role of initial pan-endoscopic tumor length at diagnosis in operable esophageal squamous cell carcinoma undergoing esophagectomy with or without neoadjuvant concurrent chemoradiotherapy

Does the Margin Matter in Esophageal Cancer

Impact of incremental circumferential resection margin distance on overall survival and recurrence in oesophageal adenocarcinoma

Contact Info

Product

Resources

About