The mode of circumferential margin involvement in rectal cancer determines its impact on outcomes: A population-based study.

Autor: Hugen N; Rijnstate, Department of Surgery, Arnhem, the Netherlands; Radboud University Medical Center, Department of Surgery, Nijmegen, the Netherlands. Electronic address: Niek.Hugen@radboudumc.nl., Voorham QJM; PALGA Foundation, Houten, the Netherlands., Beets GL; Netherlands Cancer Institute, Department of Surgery, Amsterdam, the Netherlands., Loughrey MB; Royal Victoria Hospital, Belfast Health and Social Care Trust, Department of Cellular Pathology, Belfast, UK; Queen's University Belfast, Belfast, UK., Snaebjornsson P; Netherlands Cancer Institute, Department of Pathology, Amsterdam, the Netherlands; University of Iceland, Faculty of Medicine, Reykjavik, Iceland., Nagtegaal ID; Radboud University Medical Center, Department of Pathology, Nijmegen, the Netherlands.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2024 Oct; Vol. 50 (10), pp. 108598. Date of Electronic Publication: 2024 Aug 14.
DOI: 10.1016/j.ejso.2024.108598
Abstrakt: Background: The clinical value of different modes of CRM involvement in rectal cancer patients is unclear. This study aims to determine the clinical impact of different modes of circumferential resection margin (CRM) involvement in patients with a locally advanced rectal carcinoma.
Patients and Methods: A cohort of patients who were diagnosed with stage III rectal cancer between June 2014 and June 2020 was selected from the prospective Dutch nationwide pathology databank (PALGA). Histopathological and clinical data were analyzed according to the nature of CRM involvement (via primary tumor invasion, lymph node metastasis, tumor deposit, multiple factors) and analyses on recurrence and overall survival (OS) were performed.
Results: 3020 patients were included, of whom 12.4 % had a positive CRM. The majority of these patients (63.2 %) had CRM involvement by primary tumor invasion and in 9 % of patients multiple factors caused the positive CRM. The rates of local recurrence and distant metastasis were related to the nature of the CRM involvement, with lowest rate for lymph node metastasis and highest rate for multiple factors. On multivariate analysis, CRM involvement by primary tumor invasion, tumor deposits and multiple factors, but not by lymph node metastasis, were associated with poor OS.
Conclusion: This nationwide population based study highlights the clinical importance of reporting the nature of CRM involvement in rectal cancer patients. Lymph node metastasis involving the CRM does not bear the same risks for local recurrence, distant metastases and OS as CRM involvement by primary tumor invasion or CRM involvement by multiple factors.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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