The prognostic value of circumferential resection margin involvement in oesophageal malignancy

Griffiths, Ewen A.; Brummell, Zoe; Gorthi, Ganesh; Pritchard, Sheila; Welch, I M

doi:10.1016/j.ejso.2005.11.024

Cited by 55 publications

(71 citation statements)

References 23 publications

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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%

“…It would follow that the independence of the CRM as a prognostic marker might diminish with lymph node metastases, given the relationship between lymph node metastasis and poor outcome. A number of studies15 16, 31 have stratified node‐positive patients when analysing the impact of CRM positivity on survival, but with mixed results. One study15 showed that the RCP definition of CRM was adversely prognostic only when less than 25 per cent of the lymph node yield was positive.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies15 16, 31 have stratified node‐positive patients when analysing the impact of CRM positivity on survival, but with mixed results. One study15 showed that the RCP definition of CRM was adversely prognostic only when less than 25 per cent of the lymph node yield was positive. A meta‐analysis29 concluded that the presence of lymph node metastasis appeared to negate the importance of CRM involvement.…”

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%

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

Knight

Zylstra²,

Wulaningsih

et al. 2018

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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show abstract

“…Multiple studies [120][121][122][123][124][125][126] have shown the independent prognostic value of a microscopically radical (R0) resection [120][121][122][123][124][125][126][127] .…”

Section: Radicality Of Resectionmentioning

confidence: 99%