Positive circumferential resection margins following locally advanced colon cancer surgery: Risk factors and survival impact
Positive circumferential resection margins following locally advanced colon cancer surgery: Risk factors and survival impact
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DOI：
10.1002/jso.25801
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发表时间：
2019-12-18
影响因子：
2.5
通讯作者：
Hassan, Imran
中科院分区：
文献类型：
--
作者：
Goffredo, Paolo;Zhou, Peige;Hassan, Imran
背景：虽然直肠癌环形切缘阳性的预后意义已经被证实，但其在结肠癌中的意义还没有得到很好的界定。本研究的目的是确定局部晚期结肠癌中CRM阳性的国家比率、相关因素和生存影响。方法查询国家癌症数据库，以识别2004-2015年II-III期结肠腺癌患者。结果9%的II期和12%的III期患者的CRM阳性。与阴性CRM相关的因素包括在高容量设施中进行手术、充分的淋巴结收获和阴性远端/近端切缘。两种手术方法的CRM率没有差异，尽管CRM阳性与较高的转换率显著相关。单变量和多变量分析显示，CRM阳性与总生存率显著降低相关。结论：CRM阳性率超过10%，对生存率有不利影响。虽然几种肿瘤特征被确定为独立的风险因素，但在高容量中心进行肿瘤切除和手术与较低的阳性CRM率相关。这些发现强调了针对可变因素的过程改进措施的必要性，包括采用适当的肿瘤学技术，标准化的病理报告和潜在的新辅助治疗策略。
Background While the prognostic implications of positive circumferential resection margins (CRM) have been established for rectal cancer, its significance in colon cancer has not been well defined. The aim of the current study was to determine national rates for positive CRM in locally advanced colon cancer, associated factors, and survival impact. Methods The National Cancer Database was queried to identify patients with stage II-III adenocarcinoma of the colon (2004-2015). Results Positive CRM was identified in 9% of stage II and 12% of stage III patients. Factors associated with negative CRM included surgery in a high-volume facility, adequate lymph-node harvest, and negative distal/proximal margins. No difference in CRM rates was observed between surgical approaches, although having a positive CRM was significantly associated with higher conversion rates. Positive CRM was associated with significantly lower overall survival on both univariate and multivariable analysis. Conclusions Positive CRM rates exceeded 10% nationally and have an adverse impact on survival. While several tumor characteristics were identified as independent risk factors, oncologic resections and surgery at high-volume centers were associated with lower rates of positive CRM. These findings emphasize the need for process improvement initiatives targeting modifiable factors, including adoption of appropriate oncologic techniques, standardized pathology reporting, and potential neoadjuvant strategies.