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Development and Validation of the Optimal Circumferential Resection Margin in Pathological T3 Esophageal Cancer: A Multicenter, Retrospective Study

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The clinical significance of circumferential resection margin (CRM) in esophageal squamous cell carcinoma (ESCC) remains unclear. Optimal CRM for predicting the recurrence of pathological T3 ESCC was investigated.

Methods

Seventy-three patients were retrospectively investigated in the development cohort. Patients were divided into CRM-negative and CRM-positive groups, and clinicopathological factors and survival outcomes were compared between the groups. The cutoff value was validated in another validation cohort (n = 99).

Results

Receiver operating characteristic analysis in the development cohort showed the cutoff value of CRM was 600 μm. In the validation cohort, patients in the CRM-positive group showed a significantly higher rate of locoregional recurrence (p = 0.006) and worse recurrence-free survival (RFS) (p < 0.001) than those in the CRM-negative group. Multivariate analysis identified positive CRM as an independent predictive factor for poor RFS (hazard ratio, 2.695; 95% confidence interval, 1.492–4.867; p = 0.001). The predictive value of our criteria of positive CRM for RFS was higher than that of the Royal College of Pathologists (RCP) and the College of American Pathologists (CAP) criteria. Stratified analysis in the neoadjuvant chemotherapy groups also revealed that the rate of locoregional recurrence was higher in the CRM-positive group than in the CRM-negative group both in the pathological N0 and N1–3 subgroups.

Conclusions

CRM of 600 μm can be the optimal cutoff value rather than the RCP and CAP criteria for predicting locoregional recurrence after esophagectomy. These results may support the impact of perioperative locoregional control of locally advanced ESCC.

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Acknowledgments

The authors gratefully acknowledge Satoshi Baba, the pathologist of the HUSM.

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Authors and Affiliations

  1. Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan

    Ryoma Haneda MD, Hirotoshi Kikuchi MD, PhD, Eisuke Booka MD, PhD, Tomohiro Murakami MD, PhD, Tomohiro Matsumoto MD, Yoshifumi Morita MD, PhD, Yoshihiro Hiramatsu MD, PhD & Hiroya Takeuchi MD, PhD

  2. Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan

    Ryoma Haneda MD, Shuhei Mayanagi MD, PhD & Yasuhiro Tsubosa MD, PhD

  3. Department of Diagnostic Pathology, Hamamatsu University School of Medicine, Shizuoka, Japan

    Yuka Nagakura MD

  4. Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan

    Akifumi Notsu

  5. Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, Shizuoka, Japan

    Yoshihiro Hiramatsu MD, PhD

Authors
  1. Ryoma Haneda MD
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  2. Hirotoshi Kikuchi MD, PhD
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  3. Yuka Nagakura MD
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  5. Eisuke Booka MD, PhD
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  6. Tomohiro Murakami MD, PhD
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  8. Shuhei Mayanagi MD, PhD
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Corresponding author

Correspondence to Hirotoshi Kikuchi MD, PhD.

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The authors declare no conflicts of interest for this article.

Human Rights Statement and Informed Consent

All procedures were conducted in accordance with institutional and national standards on human experimentation, as confirmed by the ethics committee of Hamamatsu University School of Medicine (approval number; 21-062) and Shizuoka Cancer Center (approval number; 2965), and with the Declaration of Helsinki of 1964 and its later versions.

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Haneda, R., Kikuchi, H., Nagakura, Y. et al. Development and Validation of the Optimal Circumferential Resection Margin in Pathological T3 Esophageal Cancer: A Multicenter, Retrospective Study. Ann Surg Oncol 29, 4452–4461 (2022). https://doi.org/10.1245/s10434-022-11491-7

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  • DOI: https://doi.org/10.1245/s10434-022-11491-7

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