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Radiological prediction of positive circumferential resection margin in oesophageal cancer.
- Source :
-
European journal of radiology [Eur J Radiol] 2018 Oct; Vol. 107, pp. 119-124. Date of Electronic Publication: 2018 Aug 30. - Publication Year :
- 2018
-
Abstract
- Purpose: A positive circumferential resection margin (CRM) is regarded as a poor prognostic indicator in oesophageal cancer (OC) but its prediction can be challenging. MRI is used to predict a threatened CRM in rectal cancer but is not commonly performed in OC unlike PET/CT, which is now routinely used. Therefore, this study assessed the additional predictive value of PET-defined tumour variables compared with EUS and CT T-stage. The prognostic significance of CRM status was also assessed.<br />Materials and Methods: This retrospective study included 117 consecutive patients [median age 64.0 (range 24-78), 102 males, 110 adenocarcinomas, 6 squamous cell carcinoma (SCC), 1 neuro-endocrine] treated between 1st March 2012 and 31st July 2015. A binary logistic regression model tested 5 staging variables; EUS T-stage (≤T2 vs ≥ T3), CT T-stage (≤T2 vs ≥ T3), PET metabolic tumour length (MTL), PET metabolic tumour width (MTW) and the maximum standardised uptake value (SUV <subscript>max</subscript> ).<br />Results: The CRM was positive in 43.6%. Sixty-seven (57.3%) patients received neo-adjuvant chemotherapy (NACT), 31 patients (26.5%) underwent surgery alone and 19 patients (16.2%) had neo-adjuvant chemo-radiotherapy (NACRT). Median overall survival (OS) was 36.0 months (95% confidence interval (CI) 24.1-47.9) and the 2-year OS was 55.4%. A binary logistic regression model showed EUS ≥ T3 tumours were independently and significantly more likely to have a positive CRM than EUS ≤ T2 tumours (HR 5.188, 95% CI 1.265-21.273, p = 0.022). CT T-stage, PET MTL, PET MTW and SUV <subscript>max</subscript> were not significantly associated with CRM status (p = 0.783, 0.852, 0.605 and 0.413, respectively). There was a significant difference in OS between CRM positive and negative groups (X <superscript>2</superscript> 4.920, df 1, p = 0.027).<br />Conclusion: Advanced EUS T-stage is associated with a positive CRM, but PET-defined tumour variables are unlikely to provide additional predictive information. This study demonstrates the continued benefit of EUS as part of a multi-modality OC staging pathway.<br /> (Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Adenocarcinoma diagnostic imaging
Adult
Aged
Carcinoma, Squamous Cell diagnostic imaging
Chemotherapy, Adjuvant
Early Detection of Cancer
Esophageal Neoplasms diagnostic imaging
Female
Humans
Logistic Models
Male
Margins of Excision
Middle Aged
Neoplasm Staging
Positron Emission Tomography Computed Tomography methods
Retrospective Studies
Young Adult
Adenocarcinoma surgery
Carcinoma, Squamous Cell surgery
Esophageal Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1872-7727
- Volume :
- 107
- Database :
- MEDLINE
- Journal :
- European journal of radiology
- Publication Type :
- Academic Journal
- Accession number :
- 30292255
- Full Text :
- https://doi.org/10.1016/j.ejrad.2018.08.027