Prognostication and optimal criteria of circumferential margin involvement for esophageal cancer after chemoradiation and esophagectomy

Ankit Potdar; Ke-Cheng Chen; Shuenn-Wen Kuo; Mong-Wei Lin; Hsien-Chi Liao; Pei-Ming Huang; Yi-Hsuan Lee; Hsiu-Po Wang; Ming-Lun Han; Chia-Hsien Cheng; Chih-Hung Hsu; Ta-Chen Huang; Feng-Ming Hsu; Shao-Lun Lu; Jang-Ming Lee

doi:10.3389/fonc.2023.1111998

Prognostication and optimal criteria of circumferential margin involvement for esophageal cancer after chemoradiation and esophagectomy

Front Oncol. 2023 Jul 12:13:1111998. doi: 10.3389/fonc.2023.1111998. eCollection 2023.

Authors

Ankit Potdar^{1

2}, Ke-Cheng Chen², Shuenn-Wen Kuo², Mong-Wei Lin², Hsien-Chi Liao², Pei-Ming Huang², Yi-Hsuan Lee³, Hsiu-Po Wang⁴, Ming-Lun Han⁴, Chia-Hsien Cheng⁵, Chih-Hung Hsu⁵, Ta-Chen Huang⁵, Feng-Ming Hsu⁵, Shao-Lun Lu⁵, Jang-Ming Lee²

Affiliations

¹ Department of Gastroenterology, Global Hospital, Mumbai, India.
² Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
³ Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.

Abstract

Purpose: Circumferential radial margin (CRM) involvement by tumor after resection for esophageal cancer has been suggested as a significant prognostic factor. However, the prognostic value of CRM involvement after surgery with neoadjuvant concurrent chemoradiotherapy (CCRT) is unclear. This study aimed to evaluate the prognostic value of and survival outcomes in CRM involvement as defined by the Royal College of Pathologists (RCP) and the College of American Pathologists (CAP) for patients with esophageal cancer undergoing neoadjuvant CCRT and esophagectomy.

Methods: A total of 299 patients with esophageal cancer who underwent neoadjuvant CCRT followed by esophagectomy between 2006 and 2016 were enrolled in our study. The CRM status of the specimens obtained was determined pathologically according to both the CAP and RCP criteria. Survival analyses were performed and compared according to the two criteria.

Results: Positive CRM was found in 102 (34.1%) and 40 (13.3%) patients according to RCP and CAP criteria, respectively. The overall and progression-free survival rates were significantly lower in the CRM-positive group than in the CRM-negative group according to both the RCP and CAP criteria. However, under multivariate analysis, in addition to pathological T and N staging of the tumor, only CAP-defined CRM positivity was a significant prognostic factor with adjusted hazard ratios of 2.64 (1.56-4.46) and 2.25 (1.34-3.78) for overall and progression-free survival, respectively (P < 0.001).

Conclusion: In patients with esophageal cancer undergoing neoadjuvant CRT followed by esophagectomy, CAP-defined CRM positivity is an independent predictor of survival. Adjuvant therapy should be offered to patients with positive CRM.

Keywords: Survival; chemoradiotherapy; circumferential radial margin; esophageal cancer; esophagectomy.

Grants and funding

This study was supported by the Ministry of Science and Technology (MOST 108-2314-B-002-017 and MOST 107-2314-B-002-248-MY3), and Taiwan Society for the Chest Care and Esophageal Disease Education Foundation.