Background: The oncologic benefit of upfront re-excision of involved margins after breast-conserving surgery in the context of current multimodal clinical management of breast cancer is unclear. The aim of the present study was to assess the 5-years locoregional recurrence (LRR)-free and distant metastases (DM)-free survival probabilities in patients not undergoing re-excision of positive margins after lumpectomy for breast cancer. Methods: A cohort of 104 patients with positive margins not undergoing re-excision was matched by propensity score with a cohort of 2006 control patients with clear margins after breast-conserving surgery, treated between 2008 and 2018. A multivariate survival analysis was performed accounting for all variables related to LRR and DM, including adjuvant treatments. Results: After adjusting for potential confounders, avoiding to re-excise a positive margin after lumpectomy had no effect on 5-years LRR-free survival probability (HR 0.98, 95%CI 0.36-2.67, p = 0.96) or 5-years DM-free survival probability (HR 0.37, 95%CI 0.08-1.61, p = 0.18). No correlation was found between occurrence of LRR and number of involved margins (HR 1.28, 95%CI 0.10-12.4, Log-rank p = 0.83), or extension of infiltrating disease (HR 1.21, 95%CI 0.20-7.40, Log-rank p = 0.83), but a trend toward higher LRR probability was found for invasive ductal (HR 6.92, 95%CI 0.7-68.8, Log-rank p = 0.10) and invasive lobular cancer (HR 12.95, 95%CI 0.79-213.6, Log-rank p = 0.07) on positive margins. Conclusions: In the era of multimodal treatment of breast cancer and accurate strategies to reduce the probability of residual disease in the post-lumpectomy cavity, re-excision of positive margins might be omitted in selected patients with low-risk breast cancers.
Involved margins after lumpectomy for breast cancer: Always to be re-excised? / L. Sorrentino, M. Agozzino, S. Albasini, D. Bossi, S. Mazzucchelli, R. Vanna, O. Papadopoulou, L. Villani, F. Corsi. - In: SURGICAL ONCOLOGY. - ISSN 0960-7404. - 30(2019 Sep), pp. 141-146.
|Titolo:||Involved margins after lumpectomy for breast cancer: Always to be re-excised?|
SORRENTINO, LUCA (Primo)
CORSI, FABIO RUGGERO MARIA (Ultimo) (Corresponding)
|Parole Chiave:||Re-excision; Breast-conserving surgery; Breast cancer; Margins|
|Settore Scientifico Disciplinare:||Settore MED/18 - Chirurgia Generale|
|Data di pubblicazione:||set-2019|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.suronc.2019.08.002|
|Appare nelle tipologie:||01 - Articolo su periodico|