AUTHOR=Tang Xin-Yi , Huang Meng-Xi , Han Si-Qi , Chang Yue , Li Zhi-Ping , Kao Xiao-Ming , Chen Yan-Yan , Liu Chao , Huang Ya-Di , Chen Yi-Tian , Lei Zeng-Jie , Chu Xiao-Yuan 

TITLE=The Circumferential Resection Margin Is a Prognostic Predictor in Colon Cancer

JOURNAL=Frontiers in Oncology

VOLUME=10

YEAR=2020

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00927

DOI=10.3389/fonc.2020.00927

ISSN=2234-943X

ABSTRACT=<p><bold>Objective:</bold> This study aimed to investigate the potential value of circumferential resection margin (CRM) in colon cancer prognostics.</p><p><bold>Summary Background Data:</bold> CRM has been extensively studied as an important prognostic factor in rectal and esophageal cancer, but not in colon cancer.</p><p><bold>Methods:</bold> Data from 6,681 CRM-positive patients and 25,908 CRM-negative patients diagnosed with colon cancer in 2010–2015 were obtained from the Surveillance, Epidemiology, and End Results database. Statistical analysis methods utilized included the chi-square test, Kaplan-Meier estimates, Cox proportional, and X-tile software analyses.</p><p><bold>Results:</bold> After propensity score matching, CRM positivity was found to be negatively related with survival <italic>(P</italic> &lt; 0.001). X-tile software identified 0 and 30 mm as optimal cutoff values (<italic>P</italic> &lt; 0.001) for prognosis, which was applicable only in stage II–IV patients. A 20 and 33% risk decrease were observed in patients with CRM between 0 and 30 mm [95% confidence interval (CI) = 0.76–0.84], and larger than 30 mm (95% CI = 0.62–0.71), respectively. Chemotherapy strongly benefited prognosis with a hazard ratio of 0.36 (95% CI = 0.34–0.38) for overall survival (OS). Patients with a CRM value of 0–30 mm seemed to benefit most from chemotherapy compared with other groups. CRM and number of regional lymph nodes are independent risk factors, and the latter is a good substitute for CRM in AJCC stage I patients.</p><p><bold>Conclusion:</bold> CRM positivity is a strong unfavorable survival indicator for colon cancer patients. A better outcome is expected with CRM values larger than 30 mm. This cutoff value only applied to stage II–IV patients. For stage I patients, number of regional lymph nodes is a good substitute to predict survival. Chemotherapy was another favorable prognostic factor, especially for patients with a CRM value between 0 and 30 mm.</p>