Is There an Optimal Definition for a Positive Circumferential Resection Margin in Locally Advanced Esophageal Cancer?

Area of Science:

• Oncology
• Surgical Pathology
• Cancer Prognostics

Background:

• Two definitions for positive circumferential resection margin (CRM) in esophageal cancer exist: College of American Pathologists (CAP) at 0 mm and Royal College of Pathologists (RCP) at ≤1 mm.
• The prognostic significance of these definitions and the potential for refined cutoffs require evaluation.

Purpose of the Study:

• To assess the prognostic value of both CAP and RCP definitions of positive CRM in esophageal cancer.
• To identify novel CRM cutoff values for improved survival prediction based on histologic type.

Main Methods:

• Retrospective analysis of 283 patients with locally advanced esophageal cancer undergoing curative resection (2007-2016).
• Reassessment of CRM using an ocular micrometer.
• Overall survival (OS) and disease-free survival (DFS) analyzed using univariate and multivariate models.

Main Results:

• Positive CRM by both CAP (HR 2.26) and RCP (HR 1.42) definitions was linked to poorer OS.
• The CAP definition (0 mm) showed superior predictive accuracy for OS and DFS compared to the RCP definition (≤1 mm).
• Optimal new CRM cutoffs identified: 100 µm for squamous cell carcinoma and 200 µm for adenocarcinoma.

Conclusions:

• The CAP definition of CRM is more accurate for predicting prognosis and recurrence in esophageal cancer.
• Novel, histology-specific CRM cutoff values can enhance survival prediction.