Naoya Okada1, Satoshi Fujii2, Takeo Fujita3, Jun Kanamori3, Takashi Kojima4, Ryuichi Hayashi5, Hiroyuki Daiko3. 1. 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. 2. Pathology Division, Research Center for Innovative Oncology, National Cancer Center at Kashiwa, Chiba, Japan. Electronic address: sfujii@east.ncc.go.jp. 3. Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. 4. Department of Gastrointestinal Oncology & Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. 5. 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.
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). CONCLUSION: Positive CRM according to CAP criteria after multimodality treatment significantly affects the overall and relapse-free survival of ESCC patients.
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). CONCLUSION: Positive CRM according to CAP criteria after multimodality treatment significantly affects the overall and relapse-free survival of ESCC patients.