Prediction of a positive circumferential resection margin at surgery following neoadjuvant chemotherapy for adenocarcinoma of the oesophagus
Background A positive circumferential resection margin (CRM) has been associated with higher rates of locoregional recurrence and worse survival in oesophageal cancer. The aim of this study was to establish if clinicopathological and radiological variables might predict CRM positivity in patients wh...
| Váldodahkkit: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Materiálatiipa: | Artihkal |
| Giella: | English |
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Oxford University Press
2019-12-01
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| Ráidu: | BJS Open |
| Liŋkkat: | https://doi.org/10.1002/bjs5.50211 |
| _version_ | 1831587401304113152 |
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| author | W. R. C. Knight C. Yip W. Wulaningsih A. Jacques N. Griffin J. Zylstra M. Van Hemelrijck N. Maisey A. Gaya C. R. Baker M. Kelly J. A. Gossage J. Lagergren D. Landau V. Goh A. R. Davies on behalf of the Guy's and St Thomas' Oesophago‐Gastric Research Group S. Ngan A. Qureshi H. Deere M. Green F. Chang U. Mahadeva B. Gill‐Barman S. George J. Dunn S. Zeki J. Meenan O. Hynes G. Tham C. Iezzi |
| author_facet | W. R. C. Knight C. Yip W. Wulaningsih A. Jacques N. Griffin J. Zylstra M. Van Hemelrijck N. Maisey A. Gaya C. R. Baker M. Kelly J. A. Gossage J. Lagergren D. Landau V. Goh A. R. Davies on behalf of the Guy's and St Thomas' Oesophago‐Gastric Research Group S. Ngan A. Qureshi H. Deere M. Green F. Chang U. Mahadeva B. Gill‐Barman S. George J. Dunn S. Zeki J. Meenan O. Hynes G. Tham C. Iezzi |
| author_sort | W. R. C. Knight |
| collection | DOAJ |
| description | Background A positive circumferential resection margin (CRM) has been associated with higher rates of locoregional recurrence and worse survival in oesophageal cancer. The aim of this study was to establish if clinicopathological and radiological variables might predict CRM positivity in patients who received neoadjuvant chemotherapy before surgery for oesophageal adenocarcinoma. Methods Multivariable analysis of clinicopathological and CT imaging characteristics considered potentially predictive of CRM was performed at initial staging and following neoadjuvant chemotherapy. Prediction models were constructed. The area under the curve (AUC) with 95% confidence intervals (c.i.) from 1000 bootstrapping was assessed. Results A total of 223 patients were included in the study. Poor differentiation (odds ratio (OR) 2·84, 95 per cent c.i. 1·39 to 6·01) and advanced clinical tumour status (T3–4) (OR 2·93, 1·03 to 9·48) were independently associated with an increased CRM risk at diagnosis. CT‐assessed lack of response (stable or progressive disease) following chemotherapy independently corresponded with an increased risk of CRM positivity (OR 3·38, 1·43 to 8·50). Additional CT evidence of local invasion and higher CT tumour volume (14 cm3) improved the performance of a prediction model, including all the above parameters, with an AUC (c‐index) of 0·76 (0·67 to 0·83). Variables associated with significantly higher rates of locoregional recurrence were pN status (P = 0·020), lymphovascular invasion (P = 0·007) and poor response to chemotherapy (Mandard score 4–5) (P = 0·006). CRM positivity was associated with a higher locoregional recurrence rate, but this was not statistically significant (P = 0·092). Conclusion The presence of advanced cT status, poor tumour differentiation, and CT‐assessed lack of response to chemotherapy, higher tumour volume and local invasion can be used to identify patients at risk of a positive CRM following neoadjuvant chemotherapy. |
| first_indexed | 2024-12-17T21:55:15Z |
| format | Article |
| id | doaj.art-7fbf3f7faa0d4cfa81a84a5495b04c5c |
| institution | Directory Open Access Journal |
| issn | 2474-9842 |
| language | English |
| last_indexed | 2024-12-17T21:55:15Z |
| publishDate | 2019-12-01 |
| publisher | Oxford University Press |
| record_format | Article |
| series | BJS Open |
| spelling | doaj.art-7fbf3f7faa0d4cfa81a84a5495b04c5c2022-12-21T21:31:09ZengOxford University PressBJS Open2474-98422019-12-013676777610.1002/bjs5.50211Prediction of a positive circumferential resection margin at surgery following neoadjuvant chemotherapy for adenocarcinoma of the oesophagusW. R. C. Knight0C. Yip1W. Wulaningsih2A. Jacques3N. Griffin4J. Zylstra5M. Van Hemelrijck6N. Maisey7A. Gaya8C. R. Baker9M. Kelly10J. A. Gossage11J. Lagergren12D. Landau13V. Goh14A. R. Davies15on behalf of the Guy's and St Thomas' Oesophago‐Gastric Research GroupS. NganA. QureshiH. DeereM. GreenF. ChangU. MahadevaB. Gill‐BarmanS. GeorgeJ. DunnS. ZekiJ. MeenanO. HynesG. ThamC. IezziDepartment of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College LondonSchool of Biomedical Engineering and Imaging Sciences, King's College LondonCancer Epidemiology and Population Health Associated Research Group, King's College LondonDepartment of Radiology, Guy's and St Thomas' Hospital, London, UKDepartment of Radiology, Guy's and St Thomas' Hospital, London, UKDepartment of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College LondonCancer Epidemiology and Population Health Associated Research Group, King's College LondonDepartment of Oncology, Guy's and St Thomas' Hospital, London, UKDepartment of Oncology, Guy's and St Thomas' Hospital, London, UKDepartment of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College LondonDepartment of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College LondonDepartment of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College LondonDepartment of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College LondonDepartment of Oncology, Guy's and St Thomas' Hospital, London, UKSchool of Biomedical Engineering and Imaging Sciences, King's College LondonDepartment of Surgery, Guy's and St Thomas' Oesophago‐Gastric Centre, King's College LondonBackground A positive circumferential resection margin (CRM) has been associated with higher rates of locoregional recurrence and worse survival in oesophageal cancer. The aim of this study was to establish if clinicopathological and radiological variables might predict CRM positivity in patients who received neoadjuvant chemotherapy before surgery for oesophageal adenocarcinoma. Methods Multivariable analysis of clinicopathological and CT imaging characteristics considered potentially predictive of CRM was performed at initial staging and following neoadjuvant chemotherapy. Prediction models were constructed. The area under the curve (AUC) with 95% confidence intervals (c.i.) from 1000 bootstrapping was assessed. Results A total of 223 patients were included in the study. Poor differentiation (odds ratio (OR) 2·84, 95 per cent c.i. 1·39 to 6·01) and advanced clinical tumour status (T3–4) (OR 2·93, 1·03 to 9·48) were independently associated with an increased CRM risk at diagnosis. CT‐assessed lack of response (stable or progressive disease) following chemotherapy independently corresponded with an increased risk of CRM positivity (OR 3·38, 1·43 to 8·50). Additional CT evidence of local invasion and higher CT tumour volume (14 cm3) improved the performance of a prediction model, including all the above parameters, with an AUC (c‐index) of 0·76 (0·67 to 0·83). Variables associated with significantly higher rates of locoregional recurrence were pN status (P = 0·020), lymphovascular invasion (P = 0·007) and poor response to chemotherapy (Mandard score 4–5) (P = 0·006). CRM positivity was associated with a higher locoregional recurrence rate, but this was not statistically significant (P = 0·092). Conclusion The presence of advanced cT status, poor tumour differentiation, and CT‐assessed lack of response to chemotherapy, higher tumour volume and local invasion can be used to identify patients at risk of a positive CRM following neoadjuvant chemotherapy.https://doi.org/10.1002/bjs5.50211 |
| spellingShingle | W. R. C. Knight C. Yip W. Wulaningsih A. Jacques N. Griffin J. Zylstra M. Van Hemelrijck N. Maisey A. Gaya C. R. Baker M. Kelly J. A. Gossage J. Lagergren D. Landau V. Goh A. R. Davies on behalf of the Guy's and St Thomas' Oesophago‐Gastric Research Group S. Ngan A. Qureshi H. Deere M. Green F. Chang U. Mahadeva B. Gill‐Barman S. George J. Dunn S. Zeki J. Meenan O. Hynes G. Tham C. Iezzi Prediction of a positive circumferential resection margin at surgery following neoadjuvant chemotherapy for adenocarcinoma of the oesophagus BJS Open |
| title | Prediction of a positive circumferential resection margin at surgery following neoadjuvant chemotherapy for adenocarcinoma of the oesophagus |
| title_full | Prediction of a positive circumferential resection margin at surgery following neoadjuvant chemotherapy for adenocarcinoma of the oesophagus |
| title_fullStr | Prediction of a positive circumferential resection margin at surgery following neoadjuvant chemotherapy for adenocarcinoma of the oesophagus |
| title_full_unstemmed | Prediction of a positive circumferential resection margin at surgery following neoadjuvant chemotherapy for adenocarcinoma of the oesophagus |
| title_short | Prediction of a positive circumferential resection margin at surgery following neoadjuvant chemotherapy for adenocarcinoma of the oesophagus |
| title_sort | prediction of a positive circumferential resection margin at surgery following neoadjuvant chemotherapy for adenocarcinoma of the oesophagus |
| url | https://doi.org/10.1002/bjs5.50211 |
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