Prognostic Value of the Circumferential Resection Margin in Esophageal Cancer Patients After Neoadjuvant Chemoradiotherapy

Hulshoff, Jan Binne; Faiz, Zohra; Karrenbeld, Arend; Kats-Ugurlu, Gürsah; Burgerhof, Johannes G. M.; Smit, Jw; Plukker, John

doi:10.1245/s10434-015-4827-2

Cited by 29 publications

(31 citation statements)

References 25 publications

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“…They also found a lower heterogeneity of the comprised study in the analyzed CAP group as compared to the RCP group [11]. These results were supported in other recent retrospective studies [3,14,17,18]. A multicenter study comprising a total of 2,815 patients after esophagectomies found a reduced overall survival for patients with a positive CRM as compared to patients with tumor-free margins (17.1 vs. 28.0 months; p < 0.001) irrespective of the nodal status [3].…”

Section: Survivalsupporting

confidence: 74%

Does the Margin Matter in Esophageal Cancer

Karstens

Izbicki²,

Reeh³

2017

Dig Surg

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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.

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Section: Survivalsupporting

confidence: 74%

Does the Margin Matter in Esophageal Cancer

Karstens

Izbicki²,

Reeh³

2017

Dig Surg

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“…The prognostic value of the oesophageal CRM has been demonstrated in many studies4 8, 10 11, 14, 15, 16 25, 26, 27, 28. A large multicentre study in 2016 9 demonstrated that the CAP definition of CRM positivity was independently predictive of poor survival, whereas a meta‐analysis29 suggested that, although the CAP definition identified the highest‐risk group, the RCP definition encompassed patients still at risk of poor survival.…”

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.…”

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

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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.

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“…Buckstein and colleagues [19] investigated the neoadjuvant radiation dose and short-and long-term outcomes in the National Cancer Database, 7325 patients with esophageal cancer receiving neoadjuvant CRT followed by curative surgery were identified and four radiation dose levels (40-41. 4 Gy, 45 Gy, 50.4 Gy, and 54 Gy) were assessed. After a median follow-up of 26.3 months, radiation dose level was not associated with differences in pCR (P = 0.21) or overall survival (P = 0.39).…”

Section: Discussionmentioning

confidence: 99%

“…R0 resection, pathological complete response (pCR) and downstaging have been regarded as strong and relevant predictors of increased survival in esophageal cancer patients who were undergoing neoadjuvant therapy [1,[4][5][6], nCRT shows the advantages of effective local therapy in combination with systemic treatment, and the benefits of the radiosensitising effect of chemotherapy compared with nCT. The recently published NeoRES trial in a mixed cohort of 181 patients with esophageal squamous cell carcinoma and adenocarcinoma of the distal esophagus, manifested that nCRT increases the pCR and R0 resection rates and decreases the proportion of patients with metastases in regional lymph nodes compared to nCT, though dose not significantly improve overall survival in squamous cell carcinoma patients [7].…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant nimotuzumab plus chemoradiotherapy compared to neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy for locally advanced esophageal squamous cell carcinoma

Chen

Hao

et al. 2018

Oncotarget

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Neoadjuvant therapy improves long-term locoregional control and overall survival after surgical resection for esophageal cancer, and neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT) are commonly used in clinical practice. Nimotuzumab is a humanized monoclonal antibody against epidermal growth factor receptor (EGFR), the efficacy of nimotuzumab added to nCRT for esophageal cancer is uncertain. We conducted this retrospective study in which combining neoadjuvant treatment of nimotuzumab with chemoradiotherapy (NimonCRT) is compared with nCRT and nCT for patients with potentially resectable locally advanced esophageal squamous cell carcinoma. One hundred ninety-five patients received neoadjuvant therapy and 172 (88.2%) underwent esophagectomy. Surgical resection was performed in 94.4% after Nimo-nCRT, versus 92.5% after nCRT and 83.5% after nCT (P = 0.026). The R0 resection rate was 100% after Nimo-nCRT, 95.9% after nCRT and 92.6% after nCT (P = 0.030). Pathological complete response (pCR) was achieved in 41.2% after Nimo-nCRT, versus 32.4% after nCRT and 14.8% after nCT (P = 0.0001). Lymph-node metastases were observed in 29.4% in the Nimo-nCRT group, versus 21.6% in the nCRT group and 35.8% in the nCT group (P = 0.093). More patients in the Nimo-nCRT and nCRT group developed grade 3 esophagitis compared to those in the nCT group, P = 0.008. There was no difference in surgical complications between the treatment groups. nCRT results in improved R0 resection, higher pCR rate, and a lower frequency of lymph node metastases compared to nCT, adding nimotuzumab to nCRT is safe and appears to facilitate complete resection and increase the pCR rate.

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Prognostic Value of the Circumferential Resection Margin in Esophageal Cancer Patients After Neoadjuvant Chemoradiotherapy

Cited by 29 publications

References 25 publications

Does the Margin Matter in Esophageal Cancer

Does the Margin Matter in Esophageal Cancer

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

Neoadjuvant nimotuzumab plus chemoradiotherapy compared to neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy for locally advanced esophageal squamous cell carcinoma

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