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Is there an optimal definition for a positive circumferential resection margin in locally advanced esophageal cancer?

Abstract : Background: Two definitions of a positive circumferential resection margin (CRM) in esophageal cancer coexist: one by the College of American Pathologists (CAP) (CRM = 0 mm) and another by the Royal College of Pathologists (RCP) (CRM <= 1 mm). This study aimed to evaluate the prognostic value of both definitions in esophageal cancer and to identify a new cutoff value for the CRM to predict survival. Methods: Patients who underwent curative esophageal resection for locally advanced (>= pT3) adenocarcinoma or squamous cell carcinoma were selected from 2007 to 2016. The CRM was reassessed using an ocular micrometer. Overall survival (OS) and disease-free survival were estimated with uni- and multivariate analyses. Results The study enrolled 283 patients: 48 with a positive CRM according to the CAP definition and 171 with a positive CRM according to the RCP definition. In the multivariate analysis, a positive CRM according to both definitions was significantly associated with a poor OS (CAP: hazard ratio [HR], 2.26, p < 0.001; RCP: HR, 1.42, p = 0.035). A CRM of 0 mm was predictive of a worse OS and DFS than a CRM of 1 mm or less (p < 0.0001), whereas no significant difference was found between a CRM greater than 1 mm and a CRM of 1 mm or less, indicating that the CAP definition was more accurate for predicting prognosis and recurrence. New cutoff CRM values of 100 mu m in squamous cell carcinoma and 200 mu m in adenocarcinoma were optimal for predicting OS. Conclusion The CAP definition was more accurate for predicting prognosis and recurrence. The study identified a new cutoff value of CRM according to histologic type.
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Soumis le : jeudi 3 mars 2022 - 17:38:26
Dernière modification le : vendredi 5 août 2022 - 11:26:02

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Baptiste Brac, C. Dufour, H. Behal, M. Vanderbeken, J. Labreuche, et al.. Is there an optimal definition for a positive circumferential resection margin in locally advanced esophageal cancer?. Annals of Surgical Oncology, Springer Verlag, 2021, 28 (13), pp.8337-8346. ⟨10.1245/s10434-021-10707-6⟩. ⟨hal-03596641⟩

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