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

초록

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 0m for discriminating survival time.Results:The partitions at and near the 500m distance from CRM generated the largest log-rank statistics (P=0.0086). Therefore, we added 500m as an additional cutoff value for a positive CRM. Compared to patients with CRM greater than 500m, patients with CRM 0m showed worse overall survival (P<0.001) and progression-free survival (P<0.001), followed by patients with 0 to 500m (P=0.008 and 0.066, respectively). In multivariable analyses, overall survival differences remained significant [0<CRM 500m vs CRM > 500m, hazards ratio (HR)=1.875, 97.5% CI: 1.243-2.829, P=0.002; CRM=0m vs CRM > 500m, 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.

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