title: Prognostic significance of circumferential resection margin involvement following oesophagectomy for cancer and the predictive role of endoluminal ultrasonography.
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+.
  
  
  CONCLUSIONS
  A positive CRM was a better predictor of DFS and OS than standard pTNM stage.
authors.affiliation: Department of Surgery, South East Wales Cancer Network, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
authors.forename: T D
authors.initials: TD
authors.lastname: Reid
authors.forename: D S Y
authors.initials: DS
authors.lastname: Chan
authors.forename: S A
authors.initials: SA
authors.lastname: Roberts
authors.forename: T D L
authors.initials: TD
authors.lastname: Crosby
authors.forename: G T
authors.initials: GT
authors.lastname: Williams
authors.forename: W G
authors.initials: WG
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D006113:United Kingdom / Q000453:epidemiology