Prognostic significance of circumferential resection margin involvement following oesophagectomy for cancer and the predictive role of endoluminal ultrasonography

T. D. Reid, D. S.Y. Chan, S. A. Roberts, T. D.L. Crosby, G. T. Williams, W. G. Lewis*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background:The optimum multimodal treatment for oesophageal cancer, and the prognostic significance of histopathological tumour involvement of the circumferential resection margin (CRM+) are uncertain. The aims of this study were to determine the prognostic significance of CRM+ after oesophagectomy and to identify endosonographic (endoluminal ultrasonography (EUS)) features that predict a threatened CRM+.Methods:Two hundred and sixty-nine consecutive patients underwent potentially curative oesophagectomy (103 surgery alone, 124 neoadjuvant chemotherapy (CS) and 42 chemoradiotherapy (CRTS)). Primary outcome measures were disease-free survival (DFS) and overall survival (OS).Results:CRM+ was reported in 98 (38.0%) of all, and in 90 (62.5%) of pT3 patients. Multivariate analysis of pathological factors revealed: lymphovascular invasion (HR 2.087, 95% CI 1.396-3.122, P<0.0001), CRM+ (HR 1.762, 95% CI 1.201-2.586, P=0.004) and lymph node metastasis count (HR 1.563, 95% CI 1.018-2.400, P=0.041) to be independently and significantly associated with DFS. Lymphovascular invasion (HR 2.160, 95% CI 1.432-3.259, P=0.001) and CRM+ (HR 1.514, 95% CI 1.000-2.292, P=0.050) were also independently and significantly associated with OS. Multivariate analysis revealed EUS T stage (T3 or T4, OR 24.313, 95% CI 7.438-79.476, P<0.0001) and use or not of CRTS (OR 0.116, 95% CI 0.035-0.382, P<0.0001) were independently and significantly associated with CRM+.Conclusion:A positive CRM was a better predictor of DFS and OS than standard pTNM stage.

Original languageEnglish
Pages (from-to)1925-1931
Number of pages7
JournalBritish Journal of Cancer
Volume107
Issue number12
DOIs
Publication statusPublished - 4 Dec 2012
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Keywords

  • circumferential resection margin
  • neoadjuvant chemoradiotherapy
  • neoadjuvant chemotherapy
  • oesophageal cancer
  • oesophagectomy

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