title: The prognostic significance of the positive circumferential resection margin in pathologic T3 squamous cell carcinoma of the esophagus with or without neoadjuvant chemotherapy.
abstract: BACKGROUND
  To improve the therapeutic strategy for esophageal squamous cell carcinoma (ESCC), combined neoadjuvant chemotherapy (NAC) followed by operative surgical resection has been applied recently to patients at clinical stages II/III. Our study aimed to elucidate the impact of the circumferential resection margin (CRM) status of surgically resected specimens on the prognosis of patients undergoing neoadjuvant therapy.
  
  
  METHODS
  We enrolled 160 consecutive ESCC patients who underwent esophagectomy. The CRM status of specimens obtained was examined pathologically according to both the College of American Pathologists (CAP) and the Royal College of Pathologists (RCP) criteria. We examined the relationship between CRM status and several clinicopathologic factors among ESCC patients with or without NAC.
  
  
  RESULTS
  The local recurrence rate was significantly higher in patients with R1 compared with that of patients with R0 according to CAP criteria (12.5% vs 0.7%; P = .02; Chi-square test). Regarding the prognosis of all patients, Kaplan-Meier analyses showed that there were significant differences between R0 and R1 groups by CAP or RCP criteria (CAP, P < .001; RCP, P = .017). Additionally, Kaplan-Meier analyses showed that R1 was a significant prognostic factor for poor survival, judged by CAP criteria in both surgery alone (P < .001) and NAC plus surgery subgroups (P < .001).
  
  
  CONCLUSIONS
  Positive CRM according to CAP criteria after multimodality treatment significantly affects the overall and relapse-free survival of ESCC patients.
authors.affiliation: Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan; Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Okada
authors.affiliation: Pathology Division, Research Center for Innovative Oncology, National Cancer Center at Kashiwa, Chiba, Japan. Electronic address: sfujii@east.ncc.go.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fujii
authors.affiliation: Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kanamori
authors.affiliation: Department of Gastrointestinal Oncology & Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kojima
authors.affiliation: Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Hayashi
authors.affiliation: Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daiko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin; D005472:Fluorouracil