New 3-Tiered Circumferential Resection Margin Criteria in Esophageal Squamous Cell Carcinoma.
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.
*Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,Republic of Korea †Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea ‡Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul,Republic of Korea and Department of Biostatistics and Bioinformatics, Duke University, Durham, NC §Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Geun Dong
GD
Lee
Seung Eun
SE
Lee
Kyoung-Mee
KM
Kim
Yong-Hee
YH
Kim
Joong Hyun
JH
Ahn
Sinho
S
Jung
Yoon-La
YL
Choi
Hyeong Ryul
HR
Kim
Seung-Il
SI
Park
Young Mog
YM
Shim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D004947:Esophagus / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis