Prognostic Value of the Circumferential Resection Margin After Curative Surgery For Rectal Cancer: A Multicenter Propensity Score–Matched Analysis
| Autor: | Galvez, Ana, Biondo, Sebastiano, Trenti, Loris, Espin-Basany, Eloy, Kraft, Miquel, Farres Coll, Ramon, Codina-Cazador, Antonio, Flor-Lorente, Blas, Garcia-Granero, Eduardo, Enriquez-Navascues, Jose M, Borda-Arrizabalaga, Nerea, Kreisler, Esther |
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| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | DISEASES OF THE COLON & RECTUM r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe instname |
| ISSN: | 0012-3706 |
| Popis: | BACKGROUND: In the past few years, positive circumferential resection margin has been found to be an indicator of advanced disease with high risk of distant recurrence rather than of local recurrence. OBJECTIVE: The objective was to analyze the prognostic impact of circumferential resection margin on local recurrence, distant recurrence, and survival rates in patients with rectal cancer. DESIGN: This was a multicenter, propensity score-matched analysis 2:1 comparing positive and negative circumferential resection margin. SETTINGS: The study was conducted at 5 high-volume centers in Spain. PATIENTS: Patients who underwent total mesorectal excision with a curative intent for middle-low rectal cancer between 2006 and 2014 were included. Clinical and histological characteristics were used for matching. MAIN OUTCOME MEASURES: The main outcomes were local recurrence, distant recurrence, overall survival, and disease-free survival. RESULTS: The unmatched initial cohort consisted of 1599 patients; 4.9% had a positive circumferential resection margin. After matching, 234 patients were included (156 with negative circumferential margin and 78 with positive circumferential margin). The median follow-up period was 52.5 months (22.0-69.5). Local recurrence was significantly higher in patients with positive circumferential margin (33.3% vs 11.5%; HR 3.2; 95% CI: 1.83-5.43; p < 0.001). Distant recurrence was similar in both groups (46.2% vs 42.3%; HR 1.09; 95% CI: 0.78-1.90; p = 0.651). There were no statistically significant differences in 5-year overall survival (48.6% vs 43.6%; HR 1.09; 95% CI: 0.92-1.78; p = 0.14). Disease-free survival was lower in patients with positive circumferential margin (36.1% vs 52.3%; HR 1.5; 95% CI: 1.05-2.06; p = 0.026). LIMITATIONS: This study was limited by its retrospective design. The different neoadjuvant treatment options were not been included in the propensity score. CONCLUSIONS: Positive circumferential resection margin is associated with higher local recurrence rate and worse disease-free survival in comparison with negative circumferential resection margin. However, positive circumferential resection margin was not a prognostic indicator of distant recurrence and overall survival. See Video Abstract at http://links.lww.com/DCR/B950. |
| Databáze: | OpenAIRE |
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