Yonsei Med J.  2013 Jan;54(1):131-138. 10.3349/ymj.2013.54.1.131.

Circumferential Resection Margin Involvement in Stage III Rectal Cancer Patients Treated with Curative Resection Followed by Chemoradiotherapy: A Surrogate Marker for Local Recurrence?

• Kang J
• Kim H
• Hur H
• Min BS
• Baik SH
• Lee KY
• Sohn SK
• Kim NK

• KMID: 1776928
• DOI: http://doi.org/10.3349/ymj.2013.54.1.131

Abstract

PURPOSE
Circumferential resection margin (CRM) involvement is a well-known predictor for poor prognosis in rectal cancer. However, the significance is controversial in some studies. Accordingly, this study attempted to examine the prognostic impact of CRM involvement in stage III rectal cancer.
MATERIALS AND METHODS
Between January 1990 and December 2007, a total of 449 patients who underwent curative resection followed by complete adjuvant chemoradiotherapy for stage III rectal cancer located within 12 cm from the anal verge were selected. Patients were divided into a CRM-positive group (n=79, 17.6%) and a CRM-negative group (n=370, 82.4%).
RESULTS
With a median follow-up of 56.6 months, recurrent disease was seen in 53.2 and 43.5% of the CRM-positive and CRM-negative group, respectively. CRM involvement was an independent prognostic factor for 5-year systemic recurrence-free survival (HR: 1.5, CI: 1.0-2.2, p=0.017). However, no significant difference was observed for local recurrence rate between the two groups (13.0 and 13.5%, respectively, p=0.677).
CONCLUSION
In this study, local recurrence rate did not differ according to CRM involvement status in stage III rectal cancer patients, although CRM involvement was shown to be an independent poor prognostic factor. Accordingly, validation of the results of this study by further large prospective randomized trials is warranted.

Keyword

Rectal neoplasm; circumferential resection margin; local recurrence; systemic metastasis; prognosis

MeSH Terms

Aged
Biological Markers
Chemoradiotherapy/*methods
Female
Fluorodeoxyglucose F18/pharmacology
Follow-Up Studies
Humans
Lymphatic Metastasis
Magnetic Resonance Imaging
Male
Middle Aged
Neoplasm Metastasis
Neoplasm Recurrence, Local
Neoplasm Staging
Positron-Emission Tomography
Prognosis
Rectal Neoplasms/diagnosis/*surgery/*therapy
Recurrence
Surgical Procedures, Operative
Tomography, X-Ray Computed
Treatment Outcome
Biological Markers
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 Pathologic findings of the CRM-positive and CRM-negative groups. The distance between the tumor and the circumferential resection margin was 1 mm (H&E staining, ×12) in the CRM-positive group (A), and 4 mm (H&E staining, ×12) in the CRM-negative group (B). CRM, circumferential resection margin.

• 

  Fig. 2 Five-year cumulative recurrence rate according to CRM status. (A) Five-year local recurrence rate in the CRM(-) group (13.5%) and CRM(+) group (13.0%) (p=0.677). (B) Five-year systemic recurrence rate in the CRM(-) group (37.1%) and CRM(+) group (48.9%) (p=0.008). CRM, circumferential resection margin.

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