1. P107 PREDICTION OF A POSITIVE CIRCUMFERENTIAL RESECTION MARGIN IN ADENOCARCINOMA OF THE ESOPHAGUS
- Author
-
Goh Vicky, Jacques Audrey, Yip Connie, Griffin Nyree, Landau David, Kelly Mark, Van Hemelrijck Mieke, R C Knight William, R Davies Andrew, Zylstra Janine, R Baker Cara, Wulaningsih Wahyu, Largergren Jesper, Gaya DrAndrew, Maisey Nick, and A Gossage James
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Gastroenterology ,medicine ,Adenocarcinoma ,Circumferential resection margin ,General Medicine ,Radiology ,Esophagus ,medicine.disease ,business - Abstract
Aim To determine if a positive circumferential resection margin (CRM) can be predicted in patients with esophageal adenocarcinoma undergoing neo-adjuvant chemotherapy prior to surgery Methods 223 patients were included in this study. Multivariable analyses of clinico-pathological and computed tomography (CT) imaging predictors were performed to evaluate the likelihood of a positive CRM at initial staging and following neoadjuvant chemotherapy, with prediction models constructed. Area under curve (AUC) with 95% confidence interval (CI) from 1000 bootstrapping was assessed. Results Advanced clinical T-stage (T3-4) (odds ratio, OR 2.93 95%CI 1.03-9.48) and poor tumor differentiation (OR 2.84, 95%CI 1.39-6.01) were independently associated with an increased risk of a positive CRM. Non response to chemotherapy as estimated by CT independently corresponded with an increased risk of CRM positivity (OR 3.38 95% CI 1.43-8.50). Additional CT evidence of local invasion/pleural thickening and higher CT tumor volume (14cm3) improved the performance of a prediction model, including all above parameters; with AUC (c-index) of 0.76 (0.68-0.83). Conclusion Combining advanced clinical T-stage, poor tumor differentiation, CT non-response to chemotherapy, higher CT tumor volume and local invasion may be helpful in selecting patients for intensification of neo-adjuvant treatment prior to resection.
- Published
- 2019