Prognostic significance of positive circumferential resection margin post neoadjuvant chemotherapy in patients with esophageal or gastro-esophageal junction adenocarcinoma
Weaver, Jamie M
AffiliationUniversity of Manchester Division of Cancer Sciences, The Christie NHS Foundation Trust, Manchester, UK
MetadataShow full item record
AbstractBACKGROUND: The aim of the present study was to assess the prognosis of patients with esophageal or gastroesophageal junction (E/GEJ) adenocarcinoma extending beyond the muscularis propria layer (?ypT3) and positive circumferential resection margin (CRM), post neoadjuvant chemotherapy. METHODS: 177 patients were retrospectively studied. The majority (94.9%) received ECX (epirubicin, cisplatin, capecitabine), and all had clear proximal/distal resection margins. CRM was defined as positive (CRM+) when it was directly infiltrated (infiltrated CRM) or when tumor cells were detected within 1 mm from CRM (close CRM) and as negative (CRM-) when tumor cells were found in a distance > 1 mm from CRM. RESULTS: CRM+ was found in 83 patients (46.9%). Of them, infiltrated CRM was recorded in 36 (20.3%) and close CRM in 47 (26.6%). Adjuvant chemotherapy was administered to 132 patients (74.6%). Lymphovascular invasion and primary site in the lower esophagus were independently associated with higher risk of CRM+. Patients with infiltrated CRM, compared to those with close CRM and those CRM-, had the shortest median time-to-relapse (11.4 vs. 15.6 vs. 22.1 months, respectively, p?=?0.005) and overall survival (18.7 vs. 23.1 vs. 38.8 months, respectively, p = 0.001). However, CRM status was not an independent predictor of poor outcome. Symptomatic isolated locoregional recurrences were rare in both CRM+ and CRM-patients (4/56 [7.1%] vs. 5/52 [9.6%], p?=?0.736), as well as in infiltrated vs. non-infiltrated CRM (CRM- and close CRM) (0/26 [0%] vs. 9/82 [11.0%], p?=?0.110). CONCLUSION: Although CRM status is associated with poor outcome, it does not represent an independent prognostic factor. The status of CRM did not significantly influence the pattern of cancer relapse
CitationPatrao A, Papaxoinis G, Kordatou Z, Weaver J, Owen-Holt V, Alkhaffaf B, et al. Prognostic significance of positive circumferential resection margin post neoadjuvant chemotherapy in patients with esophageal or gastro-esophageal junction adenocarcinoma. Eur J Surg Oncol. 2019;45(3):439-45.
JournalEuropeanJournal of Surgical Oncology
- The Role of Continuing Perioperative Chemotherapy Post Surgery in Patients with Esophageal or Gastroesophageal Junction Adenocarcinoma: a Multicenter Cohort Study.
- Authors: Papaxoinis G, Kamposioras K, Weaver JMJ, Kordatou Z, Stamatopoulou S, Germetaki T, Nasralla M, Owen-Holt V, Anthoney A, Mansoor W
- Issue date: 2019 Sep
- Prognostic value of the circumferential resection margin and its definitions in esophageal cancer patients after neoadjuvant chemoradiotherapy.
- Authors: Depypere L, Moons J, Lerut T, De Hertogh G, Peters C, Sagaert X, Coosemans W, Van Veer H, Nafteux P
- Issue date: 2018 Feb 1
- Clinical outcomes and benefits for staging of surgical lymph node mapping after esophagectomy.
- Authors: Lagarde SM, Phillips AW, Navidi M, Disep B, Griffin SM
- Issue date: 2017 Dec 1
- Influence of circumferential resection margin on prognosis in distal esophageal and gastroesophageal cancer approached through the transhiatal route.
- Authors: Scheepers JJ, van der Peet DL, Veenhof AA, Cuesta MA
- Issue date: 2009
- Neoadjuvant chemotherapy and surgery for esophageal adenocarcinoma: prognostic value of circumferential resection margin and stratification of N1 category.
- Authors: Saha AK, Sutton C, Rotimi O, Dexter S, Sue-Ling H, Sarela AI
- Issue date: 2009 May