Prognostic significance of positive circumferential resection margin post neoadjuvant chemotherapy in patients with esophageal or gastro-esophageal junction adenocarcinoma

Patrão, Ana Sofia; Papaxoinis, George; Kordatou, Zoe; Weaver, Jamie; Owen-Holt, Vikki; Alkhaffaf, Bilal; Galloway, Simon; Mansoor, Wasat

doi:10.1016/j.ejso.2018.10.530

Cited by 12 publications

(9 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 1993, the concept of CRM was introduced to the esophageal adenocarcinoma field ( 6 ), and was later verified to hold some prognostic value ( 7 , 8 ). Since then, CRM positivity continued to be studied, with different opinions arising about its prognostic significance, varying mainly due to the application of modern multidisciplinary management ( 9 ) and neoadjuvant therapy ( 10 , 11 ). Additionally, incremental benefits in survival and recurrence rates with increasing CRM values have been found in esophageal cancer ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

The Circumferential Resection Margin Is a Prognostic Predictor in Colon Cancer

et al. 2020

View full text Add to dashboard Cite

Objective: This study aimed to investigate the potential value of circumferential resection margin (CRM) in colon cancer prognostics. Summary Background Data: CRM has been extensively studied as an important prognostic factor in rectal and esophageal cancer, but not in colon cancer. Methods: Data from 6,681 CRM-positive patients and 25,908 CRM-negative patients diagnosed with colon cancer in 2010–2015 were obtained from the Surveillance, Epidemiology, and End Results database. Statistical analysis methods utilized included the chi-square test, Kaplan-Meier estimates, Cox proportional, and X-tile software analyses. Results: After propensity score matching, CRM positivity was found to be negatively related with survival (P < 0.001). X-tile software identified 0 and 30 mm as optimal cutoff values ( P < 0.001) for prognosis, which was applicable only in stage II–IV patients. A 20 and 33% risk decrease were observed in patients with CRM between 0 and 30 mm [95% confidence interval (CI) = 0.76–0.84], and larger than 30 mm (95% CI = 0.62–0.71), respectively. Chemotherapy strongly benefited prognosis with a hazard ratio of 0.36 (95% CI = 0.34–0.38) for overall survival (OS). Patients with a CRM value of 0–30 mm seemed to benefit most from chemotherapy compared with other groups. CRM and number of regional lymph nodes are independent risk factors, and the latter is a good substitute for CRM in AJCC stage I patients. Conclusion: CRM positivity is a strong unfavorable survival indicator for colon cancer patients. A better outcome is expected with CRM values larger than 30 mm. This cutoff value only applied to stage II–IV patients. For stage I patients, number of regional lymph nodes is a good substitute to predict survival. Chemotherapy was another favorable prognostic factor, especially for patients with a CRM value between 0 and 30 mm.

show abstract

Section: Introductionmentioning

confidence: 99%

The Circumferential Resection Margin Is a Prognostic Predictor in Colon Cancer

et al. 2020

View full text Add to dashboard Cite

show abstract

“…21,22 Chemotherapy is also more commonly used to treat the residual tumors after surgery. 23,24 How to reduce the side effects of systemic chemotherapy is also getting more and more attention. Some studies have shown that the drug toxicity can be effectively alleviated by local administration of slow-release materials.…”

Section: Discussionmentioning

confidence: 99%

The Delivery Materials with Chemotherapy Drugs for Treatment of the Positive Margin in Solid Tumors

Zhu

Liu

Feng

et al. 2020

Tissue Engineering Part A

View full text Add to dashboard Cite

The positive surgical margins in solid tumors has been a disturbing issue for clinicians. Chemotherapy is an important method to deal with the positive margin. However, systemic chemotherapy is required for long-term administration and has great side effects on health, which cause great pain to the patients. Local administration of slow-release materials provides an opportunity to improve the situation. In this study, we utilized electrospinning technology to create the drug sustained-release materials with nanofibrous structure, which were made from polylactic acid and a certain proportion of chemotherapy drugs (gemcitabine and cisplatin). In vitro release behavior of the drug sustained-release materials were explored by the high-performance liquid chromatography. The antitumor efficacy of the drug sustained-release materials was preliminarily verified in prostate cancer and breast cancer in vitro. Through animal models of breast cancer, the drug sustained-release materials in the treatment of the positive margin has been well documented in vivo, and we also found that the drug sustained-release materials could definitely reduce the liver damage and myelosuppression compared with systemic chemotherapy. In summary, the experimental results showed that the local administration of the drug sustained-release materials could effectively inhibit the growth of the positive incision margins and definitely reduce the partial side effects associated with systemic chemotherapy.

show abstract

“…The number of lymph nodes recovered and involved by carcinoma is important; a minimum number of lymph nodes should be sampled for accurate assessment. According to the Union for International Cancer Control (UICC)10 AJCC1 8th editions, although it is suggested that at least 16 regional lymph nodes be removed and assessed pathologically, harvesting ≥30 nodes is desirable due to the prognostic value of increased nodal yield on overall survival 130,131 . The presence or absence of regressive changes observed in lymph node metastases could be recorded, but the significance of this is still evolving.…”

Section: Lymph Node Statusmentioning

confidence: 99%

The modern management of Barrett’s oesophagus and related neoplasia: role of pathology

et al. 2020

View full text Add to dashboard Cite

Modern management of Barrett’s oesophagus and related neoplasia essentially focuses upon surveillance to detect early low‐risk neoplastic lesions and offering organ‐preserving advanced endoscopic therapies, while traditional surgical treatments of oesophagectomy and lymph node clearance with or without chemoradiation are preserved only for high‐risk and advanced carcinomas. With this evolution towards figless invasive therapy, the choice of therapy hinges upon the pathological assessment for risk stratifying patients into those with low risk for nodal metastasis who can continue with less invasive endoscopic therapies and others with high risk for nodal metastasis for which surgery or other forms of treatment are indicated. Detection and confirmation of neoplasia in the first instance depends upon endoscopic and pathological assessment. Endoscopic examination and biopsy sampling should be performed according to the recommended protocols, and endoscopic biopsy interpretation should be performed applying standard criteria using appropriate ancillary studies by histopathologists experienced in the pathology of Barrett’s disease. Endoscopic resections (ERs) are both diagnostic and curative and should be performed by clinicians who are skilled with advanced endoscopic techniques. Proper preparation and handling of ERs are essential to assess histological parameters that dictate the curative nature of the procedure. Those parameters are adequacy of resection and risk of lymph node metastasis. The risk of lymph node metastasis is determined by depth invasion and presence of poor differentiation and lymphovascular invasion. Those adenocarcinomas with invasion up to muscularis mucosae (pT1a) and those with superficial submucosal invasion (pT1b) up to 500 µ with no poor differentiation and lymphovascular invasion and negative margins may be considered cured by endoscopic resections.

show abstract

Prognostic significance of positive circumferential resection margin post neoadjuvant chemotherapy in patients with esophageal or gastro-esophageal junction adenocarcinoma

Cited by 12 publications

References 28 publications

The Circumferential Resection Margin Is a Prognostic Predictor in Colon Cancer

The Circumferential Resection Margin Is a Prognostic Predictor in Colon Cancer

The Delivery Materials with Chemotherapy Drugs for Treatment of the Positive Margin in Solid Tumors

The modern management of Barrett’s oesophagus and related neoplasia: role of pathology

Contact Info

Product

Resources

About