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New 3-Tiered Circumferential Resection Margin Criteria in Esophageal Squamous Cell Carcinoma

Authors
 Geun Dong Lee, MD, Seung Eun Lee, MD,y Kyoung-Mee Kim, MD, PhD,y Yong-Hee Kim  ;  Joong Hyun Ahn  ;  Sinho Jung  ;  Yoon-La Choi  ;  Hyeong Ryul Kim  ;  Seung-Il Park  ;  Young Mog Shim 
Citation
 ANNALS OF SURGERY, Vol.262(6) : 965-971, 2015 
Journal Title
ANNALS OF SURGERY
ISSN
 0003-4932 
Issue Date
2015
MeSH
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell/mortality ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/surgery* ; Esophageal Neoplasms/mortality ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/surgery* ; Esophagectomy* ; Esophagus/pathology* ; Esophagus/surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Survival Analysis
Keywords
criteria ; esophagus ; radial ; resection margins ; squamous cell carcinoma
Abstract
OBJECTIVE: We aimed to investigate the optimal cutoff value of circumferential resection margin (CRM) of esophageal squamous cell carcinoma (ESCC) in patients who underwent radical esophagectomy.

BACKGROUND: Tumor involvement of a CRM in ESCC has not been clearly defined.

METHODS: We reviewed 479 pT3 ESCC patients to find the optimal cutoff point of distance from CRM in addition to 0 μm for discriminating survival time.

RESULTS: The partitions at and near the 500 μm distance from CRM generated the largest log-rank statistics (P = 0.0086). Therefore, we added 500 μm as an additional cutoff value for a positive CRM. Compared to patients with CRM greater than 500 μm, patients with CRM 0 μm showed worse overall survival (P < 0.001) and progression-free survival (P < 0.001), followed by patients with 0 to 500 μm (P = 0.008 and 0.066, respectively). In multivariable analyses, overall survival differences remained significant [0 < CRM ≤ 500 μm vs CRM > 500 μm, hazards ratio (HR) = 1.875, 97.5% CI: 1.243-2.829, P = 0.002; CRM = 0 μm vs CRM > 500 μm, HR = 2.666, 97.5% CI: 1.745-4.076, P < 0.001]. In comparison of criteria from the College of American Pathologists, the Royal College of Pathologists, and this study, HRs of positive CRM (95% CI, P-value) were 1.969 (1.501-2.584, P < 0.001), 1.384 (1.039-1.844, P = 0.027), and 1.696 (1.342-2.143, P < 0.001), respectively.

CONCLUSIONS: In patients with ESCC, we developed new, 3-tiered CRM criteria providing more detailed prognostic information than the 2-tiered criteria.
Full Text
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00000658-201512000-00012&LSLINK=80&D=ovft
DOI
10.1097/SLA.0000000000001039
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Geun Dong(이근동)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/157295
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