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09.04.2018 | Original Article

The Prognostic Value of Varying Definitions of Positive Resection Margin in Patients with Colorectal Cancer Liver Metastases

verfasst von: Jane Wang, Georgios Antonios Margonis, Neda Amini, Nikolaos Andreatos, Chunhui Yuan, Christos Damaskos, Efstathios Antoniou, Nikolaos Garmpis, Stefan Buettner, Carlotta Barbon, Amar Deshwar, Jin He, Richard Burkhart, Timothy M. Pawlik, Christopher L. Wolfgang, Matthew J. Weiss

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 8/2018

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Abstract

Background

Varying definitions of resection margin clearance are currently employed among patients with colorectal cancer liver metastases (CRLM). Specifically, a microscopically positive margin (R1) has alternatively been equated with an involved margin (margin width = 0 mm) or a margin width < 1 mm. Consequently, patients with a margin width of 0–1 mm (sub-mm) are inconsistently classified in either the R0 or R1 categories, thus obscuring the prognostic implications of sub-mm margins.

Methods

Six hundred thirty-three patients who underwent resection of CRLM were identified. Both R1 definitions were alternatively employed and multivariable analysis was used to determine the predictive power of each definition, as well as the prognostic implications of a sub-mm margin.

Results

Five hundred thirty-nine (85.2%) patients had a margin width ≥ 1 mm, 42 had a sub-mm margin width, and 52 had an involved margin (0 mm). A margin width ≥ 1 mm was associated with improved survival vs. a sub-mm margin (65 vs. 36 months; P = 0.03) or an involved margin (65 vs. 33 months; P < 0.001). No significant difference in survival was detected between patients with involved vs. sub-mm margins (P = 0.31). A sub-mm margin and an involved margin were both independent predictors of worse OS (HR 1.66, 1.04–2.67; P = 0.04, and HR 2.14, 1.46–3.16; P < 0.001, respectively) in multivariable analysis. Importantly, after combining the two definitions, patients with either an involved margin or a sub-mm margin were associated with worse OS in multivariable analysis (HR 1.94, 1.41–2.65; P < 0.001).

Conclusions

Patients with involved or sub-mm margins demonstrated a similar inferior OS vs. patients with a margin width > 1 mm. Consequently, a uniform definition of R1 as a margin width < 1 mm should perhaps be employed by future studies.
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Metadaten
Titel
The Prognostic Value of Varying Definitions of Positive Resection Margin in Patients with Colorectal Cancer Liver Metastases
verfasst von
Jane Wang
Georgios Antonios Margonis
Neda Amini
Nikolaos Andreatos
Chunhui Yuan
Christos Damaskos
Efstathios Antoniou
Nikolaos Garmpis
Stefan Buettner
Carlotta Barbon
Amar Deshwar
Jin He
Richard Burkhart
Timothy M. Pawlik
Christopher L. Wolfgang
Matthew J. Weiss
Publikationsdatum
09.04.2018
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 8/2018
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-3748-3

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