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Cheun J, Lee YJ, Lee J, Shin Y, Chun JW, Baek SY, Kim H, Lee H, Yu J, Chae BJ, Han W, Lee JE. Surgical margin status and survival outcomes of breast cancer patients treated with breast-conserving surgery and whole-breast irradiation after neoadjuvant chemotherapy. Breast Cancer Res Treat. [DOI: 10.1007/s10549-021-06500-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/23/2021] [Indexed: 11/27/2022]
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Pathak M, S Deo SNV, Dwivedi SN, Vishnubhatla S, Thakur B. Comparison of hazard models with and without consideration of competing risks to assess the effect of neoadjuvant chemotherapy on locoregional recurrence among breast cancer patients. J Cancer Res Ther 2021; 17:982-987. [PMID: 34528552 DOI: 10.4103/jcrt.jcrt_49_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context While analyzing locoregional recurrences (LRRs), it is necessary to consider distant metastasis as a competing event. Because, later one is more fatal than LRR. It may change ongoing treatment of breast cancer and may alter the chance of LRR. Although some earlier studies assessed the effect of neoadjuvant chemotherapy (NACT) on LRR, they did not use competing risk regression model for it. Aims To identify the risk factors and predict LRR using competing risk hazard model and to compare them with those using conventional hazard model. Settings and Design This was a retrospective study from a tertiary care cancer hospital in India. Subjects and Methods Data of 2114 breast cancer patients undergoing surgery were used from patient's record files (1993-2014). Statistical Analysis Fine and Gray competing risk regression was used to model time from surgery to LRR, considering distant metastasis and death as the competing events. Further, cause-specific Cox regression was used to model time from surgery to LRR without considering competing risk. Results Greater than ten positive nodes (hazard ratio [HR] [95% confidence interval (CI)]: 2.19 [1.18-4.03]), skin involvement (HR [95% CI]: 2.75 [1.50-5.05]), NACT (HR [95% CI]: 1.90 [1.06-3.40]), invasive tumor in inner quadrant (HR [95% CI]: 1.78 [0.98-3.24]), and postoperative radiotherapy (HR [95% CI]: 0.52 [0.29-0.94]) were found to be significantly associated with LRR. However, conventional survival analysis ignoring competing risk overestimated cumulative incidence function and underestimated survival. Competing risk regression provided relatively more precise CI. Conclusions: Competing risks, if any, need to be incorporated in the survival analysis. NACT was found to be associated with higher risk for LRR, which may be because of administering it mainly to patients with bad prognosis. Conclusions Competing risks, if any, need to be incorporated in the survival analysis. NACT was found to be associated with higher risk for LRR, which may be because of administering it mainly to patients with bad prognosis.
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Affiliation(s)
- Mona Pathak
- Division of Biostatistics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha; Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Surya Narayana V S Deo
- Department of Surgical Oncology, BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sada Nand Dwivedi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Bhaskar Thakur
- Division of Biostatistics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Bonci EA, Țîțu Ș, Petrușan AM, Hossu C, Gâta VA, Ghomi MT, Kubelac PM, Bonci TI, Piciu A, Cosnarovici M, Hîțu L, Kirsch-Mangu AT, Pop DC, Lisencu IC, Achimaș-Cadariu P, Piciu D, Schmidt H, Fetica B. Does Surgical Margin Width Remain a Challenge for Triple-Negative Breast Cancer? A Retrospective Analysis. ACTA ACUST UNITED AC 2021; 57:medicina57030203. [PMID: 33652670 PMCID: PMC7996718 DOI: 10.3390/medicina57030203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Local and distant relapse (LR, DR) in breast cancer vary according to its molecular subtypes, with triple-negative breast cancer (TNBC) being the most aggressive. The surgical resection margin width (SRMW) for breast-conserving surgery (BCS) has been intensely debated, especially for the aforementioned subtype. The aim of this study was to examine the impact of SRMW on LR following BCS in TNBC patients. Materials and Methods: We conducted a retrospective study including all patients with TNBC for whom BCS was performed between 2005 and 2014. Results: Final analysis included a total of 92 patients, with a median tumor size of 2.5 cm (range 0-5 cm) and no distant metastasis at the time of diagnosis. A total of 87 patients had received neoadjuvant and/or adjuvant chemotherapy, and all patients had received adjuvant whole-breast radiotherapy. After a median follow-up of 110.7 months (95% CI, 95.23-126.166), there were 5 local recurrences and 8 regional/distant recurrences with an overall LR rate of 5.4%. The risk of LR and DR was similar between groups of patients with several SRMW cut-off values. Conclusions: Our study supports a safe "no ink on tumor" approach for TNBC patients treated with BCS.
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Affiliation(s)
- Eduard-Alexandru Bonci
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Ștefan Țîțu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Alexandru Marius Petrușan
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Claudiu Hossu
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Vlad Alexandru Gâta
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Morvarid Talaeian Ghomi
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
| | - Paul Milan Kubelac
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Medical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
- Correspondence: (P.M.K.); (I.C.L.)
| | - Teodora Irina Bonci
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
| | - Andra Piciu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Medical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Maria Cosnarovici
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Medical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Liviu Hîțu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
| | - Alexandra Timea Kirsch-Mangu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Radiotherapy, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Diana Cristina Pop
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Radiotherapy, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Ioan Cosmin Lisencu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
- Correspondence: (P.M.K.); (I.C.L.)
| | - Patriciu Achimaș-Cadariu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania; (A.M.P.); (C.H.)
| | - Doina Piciu
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Nuclear Medicine, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | - Hank Schmidt
- Division of Breast Surgery, Tisch Cancer Institute, Mount Sinai Health System, New York, NY 10029, USA;
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Bogdan Fetica
- 11th Department of Oncological Surgery and Gynecological Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (E.-A.B.); (Ș.Ț.); (V.A.G.); (M.T.G.); (T.I.B.); (A.P.); (M.C.); (L.H.); (A.T.K.-M.); (D.C.P.); (P.A.-C.); (D.P.); (B.F.)
- Department of Anatomical Pathology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
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Paul K, Ladani L. Relationship between peak density and acoustic scattering in high-frequency ultrasound wave propagation. SN Appl Sci 2020; 2:1418. [DOI: 10.1007/s42452-020-03208-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Shah C, Hobbs BP, Vicini F, Al-Hilli Z, Manyam BV, Verma V, Jia X, Goldstein N, Recht A. The Diminishing Impact of Margin Definitions and Width on Local Recurrence Rates following Breast-Conserving Therapy for Early-Stage Invasive Cancer: A Meta-Analysis. Ann Surg Oncol 2020; 27:4628-4636. [PMID: 32712894 DOI: 10.1245/s10434-020-08878-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal tumor-free margin definition and width following breast-conserving therapy (BCT) for early-stage invasive cancers has been evaluated in previous meta-analyses and guidelines. We performed an updated meta-analysis to assess how improvements in treatment over time have affected the impact of margins on local recurrence (LR) rates over time. METHODS A systematic literature review identified 38 eligible studies comprising 54,502 patients treated between 1968 and 2010. Inclusion criteria included patients treated with BCT and minimum follow-up of 50 months, pathologic definitions of margin status explicitly stated, and LR data in relation to margin status. Data were pooled using a Bayesian logistic regression model to evaluate the risk of LR in relation to both margin status and study enrollment periods. RESULTS Median follow-up was 7.25 years. Absolute LR rates decreased over time for each margin width cohort, with maximum differences between negative margin groups of less than 1% for the most recent enrollment period. However, relative rates of LR between different margin groups remained stable over time. CONCLUSIONS With an additional 22,000 patients compared with the previous meta-analysis, this updated meta-analysis supports the consensus guideline of "no tumor on ink" for the majority of patients. Additionally, while concerns exist regarding a benefit with wider margins from previous studies, the analysis demonstrates the impact of margin width on LR rates has declined substantially over time, with very small differences between the narrowest and widest margin groups in the most recent cohort. Hence, older studies appear to have limited value to inform current management guidelines.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Brian P Hobbs
- Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Frank Vicini
- 21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI, USA
| | - Zahraa Al-Hilli
- Department of Breast Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bindu V Manyam
- Department of Radiation Oncology, Alleghany Health Network, Pittsburgh, PA, USA
| | - Vivek Verma
- Department of Radiation Oncology, Alleghany Health Network, Pittsburgh, PA, USA
| | - Xuefei Jia
- Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Abram Recht
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Lai HW, Huang RH, Wu YT, Chen CJ, Chen ST, Lin YJ, Chen DR, Lee CW, Wu HK, Lin HY, Kuo SJ. Clinicopathologic factors related to surgical margin involvement, reoperation, and residual cancer in primary operable breast cancer – An analysis of 2050 patients. Eur J Surg Oncol 2018; 44:1725-1735. [DOI: 10.1016/j.ejso.2018.07.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 07/04/2018] [Accepted: 07/23/2018] [Indexed: 12/23/2022] Open
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McClatchy DM, Zuurbier RA, Wells WA, Paulsen KD, Pogue BW. Micro-computed tomography enables rapid surgical margin assessment during breast conserving surgery (BCS): correlation of whole BCS micro-CT readings to final histopathology. Breast Cancer Res Treat 2018; 172:587-595. [PMID: 30225621 PMCID: PMC6245085 DOI: 10.1007/s10549-018-4951-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/01/2018] [Indexed: 11/28/2022]
Abstract
Background Roughly 23% of breast conserving surgery (BCS) patients undergo a second re-excision procedure due to pathologically positive surgical margins. We investigated the feasibility and potential value of micro-Computed Tomography (micro-CT) as a surgical margin guidance tool during BCS. Methods A cohort of 32 BCS specimens was prospectively imaged with a pre-clinical micro-CT system upon arrival in the surgical pathology laboratory. Reconstructed micro-CT scans were evaluated retrospectively by an experienced breast radiologist, who provided binary determinations whether lesions extended to the specimen margin. These readings were then compared to the final pathological diagnosis and to 2D specimen radiography readings. Results Of the 32 specimens imaged, 28 had malignant and four had benign pathological diagnoses. Overall five (four malignant, one benign) of the 32 specimens had lesion tissue extending to the margin. For all 32 specimens, micro-CT reconstructions were calculated (< 4 min. acquisition + reconstruction time) and each specimen was volumetrically analyzed by a radiologist. Of the 28 malignant specimen readings, 18 matched the final pathological diagnosis [64%, 95 CI (47%–81%)], with a negative predictive value of 89% [95 CI (74%–96%)]. Micro-CT readings revealed changes in the tumor location and margin status as compared to single-projection radiography readings. Conclusions Micro-CT scanning of BCS specimens enabled margin status assessment over the entirety of the surgical surface in a clinically relevant time frame, provided additional spatial information over single-projection radiography, and may be a potentially useful BCS guidance tool. Electronic supplementary material The online version of this article (10.1007/s10549-018-4951-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David M McClatchy
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH, 03755, USA. .,Department of Radiation Oncology, Massachusetts General Hospital, 5 Fruit Street, Boston, MA, 02114, USA.
| | - Rebecca A Zuurbier
- Department of Radiology, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH, 03755, USA.,Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH, 03755, USA
| | - Wendy A Wells
- Department of Pathology, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH, 03755, USA.,Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH, 03755, USA
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH, 03755, USA.,Department of Radiology, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH, 03755, USA.,Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH, 03755, USA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH, 03755, USA.,Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Road, Hanover, NH, 03755, USA
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Kahlert S, Kolben TM, Schmoeckel E, Czogalla B, Hester A, Degenhardt T, Kempf C, Mahner S, Harbeck N, Kolben T. Prognostic impact of residual disease in simultaneous additional excision specimens after one-step breast conserving therapy with negative final margin status in primary breast cancer. Eur J Surg Oncol 2018; 44:1318-1323. [PMID: 30041974 DOI: 10.1016/j.ejso.2018.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The purpose of this study was the evaluation of risk factors for local recurrence after breast conserving surgery (BCS) with special focus on the impact of residual disease in specimens of simultaneous additional excisions (AE) from the tumor cavity on patients' outcome in patients with negative final margin status after one-step BCS. METHODS This study was designed as a single center retrospective cohort study. Patients with primary non-metastatic breast cancer treated by one-step BCS with pathologically confirmed negative resection status between 1990 and 2006 were included. Ipsilateral breast tumor recurrence (IBTR) and overall survival (OS) were evaluated by Kaplan-Meier-estimates. A multivariate Cox proportional hazards regression model was used to identify potential independent prognostic factors associated with the risk of IBTR. RESULTS A total of 1081 patients were included in this analysis. Simultaneous additional excisions were performed in 79.4% of patients (tumor positive: 12.2%). Median follow-up after primary diagnosis was 124 months. The IBTR rate after 15 years was significantly higher in the group with tumor positive AE (no AE (10.2%) vs. AE tumor positive (27.5%) p = 0.002; AE tumor negative (14.0%) vs. AE tumor positive (27.5%) p = 0.008). The OS rate did not differ significantly between groups. Multivariate analysis revealed residual cancer in AE being associated with a significantly increased relative risk of IBTR of 2.0 (p = 0.014). CONCLUSION In the current analysis residual disease in simultaneous additional excisions was associated with an increased risk for IBTR despite negative final margin status. This should be considered in the overall therapeutic concept.
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Affiliation(s)
- Steffen Kahlert
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 15, 81377 Munich, Germany
| | - Theresa M Kolben
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 15, 81377 Munich, Germany
| | - Elisa Schmoeckel
- Department of Pathology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Bastian Czogalla
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 15, 81377 Munich, Germany
| | - Anna Hester
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 15, 81377 Munich, Germany
| | - Tom Degenhardt
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 15, 81377 Munich, Germany
| | - Cordula Kempf
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 15, 81377 Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 15, 81377 Munich, Germany
| | - Nadia Harbeck
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 15, 81377 Munich, Germany
| | - Thomas Kolben
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 15, 81377 Munich, Germany.
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Valero MG, Mallory MA, Losk K, Tukenmez M, Hwang J, Camuso K, Bunnell C, King T, Golshan M. Surgeon Variability and Factors Predicting for Reoperation Following Breast-Conserving Surgery. Ann Surg Oncol 2018; 25:2573-2578. [PMID: 29786129 DOI: 10.1245/s10434-018-6526-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Reoperation after breast-conserving surgery (BCS) is common and has been partially associated with the lack of consensus on margin definition. We sought to investigate factors associated with reoperations and variation in reoperation rates across breast surgeons at our cancer center. METHODS Retrospective analyses of patients with clinical stage I-II breast cancer who underwent BCS between January and December 2014 were conducted prior to the recommendation of 'no ink on tumor' margin. Patient demographics and tumor and surgical data were extracted from medical records. A multivariate regression model was used to identify factors associated with reoperation. RESULTS Overall, 490 patients with stage I (n = 408) and stage II (n = 89) breast cancer underwent BCS; seven patients had bilateral breast cancer and underwent bilateral BCS procedures. Median invasive tumor size was 1.1 cm, reoperation rate was 22.9% (n = 114) and varied among surgeons (range 15-40%), and, in 100 (88%) patients, the second procedure was re-excision, followed by unilateral mastectomy (n = 7, 6%) and bilateral mastectomy (n = 7, 6%). Intraoperative margin techniques (global cavity or targeted shaves) were utilized in 50.1% of cases, while no specific margin technique was utilized in 49.9% of cases. Median total specimen size was 65.8 cm3 (range 24.5-156.0). In the adjusted model, patients with multifocal disease were more likely to undergo reoperation [odds ratio (OR) 5.78, 95% confidence interval (CI) 2.17-15.42]. In addition, two surgeons were found to have significantly higher reoperation rates (OR 6.41, 95% CI 1.94-21.22; OR 3.41, 95% CI 1.07-10.85). CONCLUSIONS Examination of BCS demonstrated variability in reoperation rates and margin practices among our breast surgeons. Future trials should look at surgeon-specific factors that may predict for reoperations.
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Affiliation(s)
- Monica G Valero
- Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Melissa Anne Mallory
- Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Katya Losk
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Mustafa Tukenmez
- Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | | | - Kristen Camuso
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Craig Bunnell
- Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Tari King
- Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mehra Golshan
- Department of Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Watanabe G, Itoh M, Duan X, Watabe H, Mori N, Tada H, Suzuki A, Miyashita M, Ohuchi N, Ishida T. 18F-fluorodeoxyglucose specimen-positron emission mammography delineates tumour extension in breast-conserving surgery: Preliminary results. Eur Radiol 2018; 28:1929-37. [DOI: 10.1007/s00330-017-5170-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/30/2017] [Accepted: 11/03/2017] [Indexed: 11/26/2022]
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11
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Vos EL, Gaal J, Verhoef C, Brouwer K, van Deurzen CHM, Koppert LB. Focally positive margins in breast conserving surgery: Predictors, residual disease, and local recurrence. Eur J Surg Oncol 2017; 43:1846-1854. [PMID: 28688723 DOI: 10.1016/j.ejso.2017.06.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/30/2017] [Accepted: 06/06/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Re-excision after breast conserving surgery (BCS) for invasive breast cancer (IBC) can be omitted for focally positive margins in the Netherlands, but this guideline is not routinely followed. Focally positive and extensively positive margins have rarely been studied separately and compared to negative margins regarding clinicopathological predictors, residual disease incidence, and local recurrence. METHODS All females with BCS for Tis-T3, without neo-adjuvant chemotherapy between 2005 and 2014 at one university hospital were included. Clinicopathological and follow-up information was collected from electronic patient records. Index tumor samples from all patients with re-excision were reviewed by one pathologist. Margins were classified as negative (≥2 mm width), close (<2 mm width), focally positive (≤4 mm length of tumor touching inked margin), or extensively positive (>4 mm length). RESULTS From 499 patients included, 212 (43%) had negative, 161 (32%) had close, 59 (12%) had focally positive, and 67 (13%) had extensively positive margins. Increasingly involved margins were associated with lobular type, tumor size, and adjacent DCIS in IBC patients and lesion size in purely DCIS patients. In IBC patients, 17%, 49%, and 77% had re-excision after close, focally positive, and extensively positive margins and residual disease incidence was 55%, 50%, and 70% respectively. In purely DCIS patients, 26 (65%), 13 (87%), and 16 (94%) had re-excision after close, focally positive, and extensively positive margins and residual disease incidence was 39%, 46%, and 90% respectively. CONCLUSION Incidence of residual disease after focally positive margins was not different from close margins, but was significantly higher after extensively positive margins. We recommend quantifying extent of margin involvement in all pathology reports.
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Affiliation(s)
- E L Vos
- Department of Surgery, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE, Rotterdam, The Netherlands
| | - J Gaal
- Department of Pathology, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - C Verhoef
- Department of Surgery, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE, Rotterdam, The Netherlands
| | - K Brouwer
- Department of Surgery, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE, Rotterdam, The Netherlands
| | - C H M van Deurzen
- Department of Pathology, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - L B Koppert
- Department of Surgery, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE, Rotterdam, The Netherlands.
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Mallory MA, Sagara Y, Aydogan F, DeSantis S, Jayender J, Caragacianu D, Gombos E, Vosburgh KG, Jolesz FA, Golshan M. Feasibility of Intraoperative Breast MRI and the Role of Prone Versus Supine Positioning in Surgical Planning for Breast-Conserving Surgery. Breast J 2017; 23:713-717. [PMID: 28295903 DOI: 10.1111/tbj.12796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We assessed the feasibility of supine intraoperative MRI (iMRI) during breast-conserving surgery (BCS), enrolling 15 patients in our phase I trial between 2012 and 2014. Patients received diagnostic prone MRI, BCS, pre-excisional supine iMRI, and postexcisional supine iMRI. Feasibility was assessed based on safety, sterility, duration, and image-quality. Twelve patients completed the study; mean duration = 114 minutes; all images were adequate; no complications, safety, or sterility issues were encountered. Substantial tumor-associated changes occurred (mean displacement = 67.7 mm, prone-supine metric, n = 7). We have demonstrated iMRI feasibility for BCS and have identified potential limitations of prone breast MRI that may impact surgical planning.
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Affiliation(s)
- Melissa A Mallory
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yasuaki Sagara
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Fatih Aydogan
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stephen DeSantis
- Breast Oncology Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jagadeesan Jayender
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Diana Caragacianu
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eva Gombos
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kirby G Vosburgh
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ferenc A Jolesz
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mehra Golshan
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts
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Mihalcik SA, Rawal B, Braunstein LZ, Capuco A, Wong JS, Punglia RS, Bellon JR, Harris JR. The Impact of Reexcision and Residual Disease on Local Recurrence Following Breast-Conserving Therapy. Ann Surg Oncol 2017; 24:1868-1873. [DOI: 10.1245/s10434-016-5727-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 11/18/2022]
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Fitzgerald S, Romanoff A, Cohen A, Schmidt H, Weltz C, Bleiweis IJ, Jaffer S, Port ER. Close and Positive Lumpectomy Margins are Associated with Similar Rates of Residual Disease with Additional Surgery. Ann Surg Oncol 2016; 23:4270-4276. [DOI: 10.1245/s10434-016-5490-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Indexed: 11/18/2022]
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Rosenberger LH, Mamtani A, Fuzesi S, Stempel M, Eaton A, Morrow M, Gemignani ML. Early Adoption of the SSO-ASTRO Consensus Guidelines on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Stage I and II Invasive Breast Cancer: Initial Experience from Memorial Sloan Kettering Cancer Center. Ann Surg Oncol 2016; 23:3239-46. [PMID: 27411549 DOI: 10.1245/s10434-016-5397-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Reexcision rates in patients undergoing breast-conserving surgery (BCS) for early-stage invasive breast cancer are highly variable. The Society of Surgical Oncology (SSO) and American Society for Radiation Oncology (ASTRO) published consensus guidelines to help standardize practice. We sought to determine reexcision rates before and after guideline adoption at our institution. METHODS We identified patients with stage I or II invasive breast cancer initially treated with BCS between June 1, 2013, and October 31, 2014. Margins were defined as positive (tumor on ink), close (≤1 mm), or negative (>1 mm), and were recorded for both invasive cancer and ductal carcinoma-in situ (DCIS) components. Reexcision rates were quantified, characteristics were compared between groups, and multivariable logistic regression was performed. RESULTS A total of 1205 patients were identified, 504 before and 701 after the guideline adoption (January 1, 2014). Clinical and pathologic characteristics were similar between time periods. Reexcision rates significantly declined from 21.4 to 15.1 % (p = 0.006) after guideline adoption. A multivariable model identified extensive intraductal component (odds ratio [OR] 2.5, 95 % confidence interval [CI] 1.2-5.2), multifocality (OR 2.0, 95 % CI 1.2-3.6), positive (OR 844.4, 95 % CI 226.3-5562.5) and close (OR 38.3, 95 % CI 21.5-71.8) ductal carcinoma-in situ margin, positive (OR 174.2, 95 % CI 66.2-530.0) and close (OR 6.4, 95 % CI 3.0-13.6) invasive margin, and time period (OR 0.5, 95 % CI 0.3-0.9 for post vs. pre) as independently associated with reexcision. CONCLUSIONS Overall reexcision rates declined significantly after guideline adoption. Close invasive margins were associated with higher rates of reexcision than negative invasive margins in both time periods; however, the effect diminished in the postguideline adoption period. Thus, we expect continued decline in reexcision rates as adherence to guidelines becomes more uniform.
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Affiliation(s)
- Laura H Rosenberger
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anita Mamtani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarah Fuzesi
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne Eaton
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Gombos EC, Jayender J, Richman DM, Caragacianu DL, Mallory MA, Jolesz FA, Golshan M. Intraoperative Supine Breast MR Imaging to Quantify Tumor Deformation and Detection of Residual Breast Cancer: Preliminary Results. Radiology 2016; 281:720-729. [PMID: 27332738 DOI: 10.1148/radiol.2016151472] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To use intraoperative supine magnetic resonance (MR) imaging to quantify breast tumor deformation and displacement secondary to the change in patient positioning from imaging (prone) to surgery (supine) and to evaluate residual tumor immediately after breast-conserving surgery (BCS). Materials and Methods Fifteen women gave informed written consent to participate in this prospective HIPAA-compliant, institutional review board-approved study between April 2012 and November 2014. Twelve patients underwent lumpectomy and postsurgical intraoperative supine MR imaging. Six of 12 patients underwent both pre- and postsurgical supine MR imaging. Geometric, structural, and heterogeneity metrics of the cancer and distances of the tumor from the nipple, chest wall, and skin were computed. Mean and standard deviations of the changes in volume, surface area, compactness, spherical disproportion, sphericity, and distances from key landmarks were computed from tumor models. Imaging duration was recorded. Results The mean differences in tumor deformation metrics between prone and supine imaging were as follows: volume, 23.8% (range, -30% to 103.95%); surface area, 6.5% (range, -13.24% to 63%); compactness, 16.2% (range, -23% to 47.3%); sphericity, 6.8% (range, -9.10% to 20.78%); and decrease in spherical disproportion, -11.3% (range, -60.81% to 76.95%). All tumors were closer to the chest wall on supine images than on prone images. No evidence of residual tumor was seen on MR images obtained after the procedures. Mean duration of pre- and postoperative supine MR imaging was 25 minutes (range, 18.4-31.6 minutes) and 19 minutes (range, 15.1-22.9 minutes), respectively. Conclusion Intraoperative supine breast MR imaging, when performed in conjunction with standard prone breast MR imaging, enables quantification of breast tumor deformation and displacement secondary to changes in patient positioning from standard imaging (prone) to surgery (supine) and may help clinicians evaluate for residual tumor immediately after BCS. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Eva C Gombos
- From the Departments of Breast Imaging (E.C.G.), Radiology (J.J., D.M.R., F.A.J.), and Surgery (D.L.C., M.A.M., M.G.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Jagadeesan Jayender
- From the Departments of Breast Imaging (E.C.G.), Radiology (J.J., D.M.R., F.A.J.), and Surgery (D.L.C., M.A.M., M.G.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Danielle M Richman
- From the Departments of Breast Imaging (E.C.G.), Radiology (J.J., D.M.R., F.A.J.), and Surgery (D.L.C., M.A.M., M.G.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Diana L Caragacianu
- From the Departments of Breast Imaging (E.C.G.), Radiology (J.J., D.M.R., F.A.J.), and Surgery (D.L.C., M.A.M., M.G.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Melissa A Mallory
- From the Departments of Breast Imaging (E.C.G.), Radiology (J.J., D.M.R., F.A.J.), and Surgery (D.L.C., M.A.M., M.G.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Ferenc A Jolesz
- From the Departments of Breast Imaging (E.C.G.), Radiology (J.J., D.M.R., F.A.J.), and Surgery (D.L.C., M.A.M., M.G.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Mehra Golshan
- From the Departments of Breast Imaging (E.C.G.), Radiology (J.J., D.M.R., F.A.J.), and Surgery (D.L.C., M.A.M., M.G.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
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Bodilsen A, Bjerre K, Offersen BV, Vahl P, Amby N, Dixon JM, Ejlertsen B, Overgaard J, Christiansen P. Importance of margin width in breast-conserving treatment of early breast cancer. J Surg Oncol 2016; 113:609-15. [DOI: 10.1002/jso.24224] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 02/28/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Anne Bodilsen
- Department of Breast and Endocrine Surgery; Aarhus University Hospital; Aarhus Denmark
| | - Karsten Bjerre
- Danish Breast Cancer Cooperative Group; Copenhagen Denmark
| | | | - Pernille Vahl
- Department of Pathology; Aarhus University Hospital; Aarhus Denmark
| | - Nikolaj Amby
- Department of Oncology; Aarhus University Hospital; Aarhus Denmark
| | - J. Michael Dixon
- Breakthrough Research Unit Edinburgh Breast Unit; Western General Hospital; Edinburgh United Kingdom
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group; Copenhagen Denmark
- Department of Oncology; Copenhagen University Hospital; Rigshospitalet Copenhagen Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology; Aarhus University Hospital; Aarhus Denmark
| | - Peer Christiansen
- Department of Surgery P, Breast Surgery Unit; Aarhus University Hospital/Randers Regional Hospital; Aarhus Denmark
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Chen C, Li Z, Yang Y, Xiang T, Song W, Liu S. Microarray expression profiling of dysregulated long non-coding RNAs in triple-negative breast cancer. Cancer Biol Ther 2016; 16:856-65. [PMID: 25996380 DOI: 10.1080/15384047.2015.1040957] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Triple-negative breast cancer (TNBC) represents a collection of malignant breast tumors that are often aggressive and have an increased risk of metastasis and relapse. Long non-coding RNAs are generally defined as RNA transcripts measuring 200 nucleotides or longer that do not encode for any protein. During the past decade, increasing evidence has shown that lncRNAs play important roles in oncogenesis and tumor suppression; however, the roles of lncRNAs in TNBC are poorly understood. To address this issue, we used Agilent human lncRNA microarray chips and bioinformatics tools, including Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG), to assess lncRNA expression in 3 pairs of TNBC tissues. A dysregulated lncRNA expression profile was identified by microarray and verified by qRT-PCR in 48 pairs of breast cancer subtype tissues. Metastasis is the major cause of cancer-related deaths, including those in TNBC, and the presence of dormant residual disseminated tumor cells (DTC) may be a key factor leading to metastasis. ANKRD30A, a potential target for breast cancer immunotherapy, is currently one of the most used DTC markers. Notably, we found the expression levels of the novel intergenic lncRNA LINC00993 to be associated with the expression levels of ANKRD30A. Furthermore, our qRT-PCR data indicated that the expression of LINC00993 was also associated with the expression of the estrogen receptor. In conclusion, our study identified a set of lncRNAs that were consistently aberrantly expressed in TNBC, and these dysregulated lncRNAs may be involved in the development and/or progression of TNBC.
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Affiliation(s)
- Chen Chen
- a Department of Surgery ; The First Affiliated Hospital of Chongqing Medical University ; Chongqing , China
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Sadek BT, Homayounfar G, Abi Raad RF, Niemierko A, Shenouda MN, Keruakous AR, Specht MC, Taghian AG. Is a higher boost dose of radiation necessary after breast-conserving therapy for patients with breast cancer with final close or positive margins? Breast Cancer Res Treat 2015; 154:71-9. [PMID: 26420403 DOI: 10.1007/s10549-015-3579-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/19/2015] [Indexed: 10/23/2022]
Abstract
To determine rates of loco-regional recurrence (LRR), distant failure and overall survival for patients with breast cancer treated with breast-conserving therapy (BCT) with a close or positive surgical margin (C/PM) treated with standard dose boost radiation compared with a higher boost of radiation. We retrospectively studied 1476 patients with T1-T3 invasive breast cancer treated with BCT between 1992 and 2009. Median age was 57 years. Patients were divided into three groups: Group I included 1197 patients (81 %) with negative margins who received a standard boost (median 60 Gy) total dose to the lumpectomy cavity; Group II included 116 patients (8 %) with C/PM who received a standard boost (median 60 Gy); and Group III included 163 patients (11 %) with C/PM who received a higher boost (median 68 Gy). Biological subtypes (e.g., ER, PR, HER2/neu) were available for 858 patients (58 %) and were also assessed for any relationship to LRR rate. The Kaplan-Meier, Cox-regression, and log-rank tests were used to estimate rates of LRR and the significance of risk factors. Median follow-up was 8.6 years. The overall 5- and 10-year cumulative incidences of LRR were 2.1 % (95 % CI 0.8-2.1 %) and 4.5 % (95 % CI 3.4-6.0 %), respectively. The 5- and 10-year cumulative incidences of LRR for Group I (negative margins + standard boost) were 1.9 and 4.4 %; for Group II (C/PM + standard boost) were 3.9 and 7.0 %; and for Group III (C/PM + higher boost) were 2.9 and 3.8 %, respectively. No statistically significant differences in LRR rates were found among the three groups (p = 0.4). Similar results were obtained for distant failure (p = 0.3) and overall survival (p = 0.4). On multivariate analysis, tumor grade (p = 0.03), systemic-therapy (p = 0.005), node positivity (p = 0.05), young age (p = 0.001), and biological subtype (p = 0.04) were statistically significantly associated with higher LRR. Higher boost dose and margin positivity were not significant. Our data suggest that the 10-year risk of local recurrence for patients with close or positive margins receiving a standard boost was 7 % compared to 3.8 % for those receiving a higher boost; however, this difference was not significant. A higher boost dose did not significantly improve local control, nor did margins impact LRR risk in our cohort of patients.
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Affiliation(s)
- Betro T Sadek
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Cox 3 Building, 100 Blossom St., Boston, MA, 02114, USA.,Family Medicine Residency Program, Mercy Health, Toledo, OH, 43604, USA
| | - Gelareh Homayounfar
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Cox 3 Building, 100 Blossom St., Boston, MA, 02114, USA.,Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY, 11203, USA
| | - Rita F Abi Raad
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Cox 3 Building, 100 Blossom St., Boston, MA, 02114, USA
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Cox 3 Building, 100 Blossom St., Boston, MA, 02114, USA.,Statistics Section, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Mina N Shenouda
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Cox 3 Building, 100 Blossom St., Boston, MA, 02114, USA.,Department of Internal Medicine, Marshals University, Huntington, WV, 25701, USA
| | - Amany R Keruakous
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Cox 3 Building, 100 Blossom St., Boston, MA, 02114, USA.,Department of Internal Medicine, University of Toledo, Toledo, OH, 43614, USA
| | - Michelle C Specht
- Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Cox 3 Building, 100 Blossom St., Boston, MA, 02114, USA.
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Golshan M, Sagara Y, Wexelman B, Aydogan F, Desantis S, Elise Min H, Vosburgh K, Jagadeesan J, Caragacianu D, Gombos E, Jolesz FA. Pilot study to evaluate feasibility of image-guided breast-conserving therapy in the advanced multimodal image-guided operating (AMIGO) suite. Ann Surg Oncol 2015; 21:3356-7. [PMID: 25047476 DOI: 10.1245/s10434-014-3926-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The rate of reexcision in breast-conserving surgery remains high, leading to delay in initiation of adjuvant therapy, increased cost, increased complications, and negative psychological impact to the patient.1 (-) 3 We initiated a phase 1 clinical trial to determine the feasibility of the use of intraoperative magnetic resonance imaging (MRI) to assess margins in the advanced multimodal image-guided operating (AMIGO) suite. METHODS All patients received contrast-enhanced three-dimensional MRI while under general anesthesia in the supine position, followed by standard BCT with or without wire guidance and sentinel node biopsy. Additional margin reexcision was performed of suspicious margins and correlated to final pathology (Fig. 1). Feasibility was assessed via two components: demonstration of safety and sterility and acceptable duration of the operation and imaging; and adequacy of intraoperative MRI imaging for interpretation and its comparison to final pathology. Fig. 1 Schema of AMIGO trial RESULTS Eight patients (mean age 48.5 years), 4 with stage I breast cancer and 4 with stage II breast cancer, were recruited. All patients underwent successful BCT in the AMIGO suite with no AMIGO-specific complications or break in sterility during surgery. The mean operative time was 113 min (range 93-146 min). CONCLUSIONS Our experience with AMIGO suggests that it is feasible to use intraoperative MRI imaging to evaluate margin assessment in real time. Further research is required to identify modalities that will lead to a reduction in reexcision in breast cancer therapy.
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Affiliation(s)
- Mehra Golshan
- Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA,
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22
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Szalayova G, James TA, Rincon M. A framework for the role of acute inflammation in tumor progression. Breast Cancer Res Treat 2015; 151:235-8. [DOI: 10.1007/s10549-015-3392-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/15/2015] [Indexed: 01/21/2023]
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Verhoeven K, Kindts I, Laenen A, Peeters S, Janssen H, Van Limbergen E, Weltens C. A comparison of three different radiotherapy boost techniques after breast conserving therapy for breast cancer. Breast 2015; 24:391-6. [PMID: 25819427 DOI: 10.1016/j.breast.2015.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/22/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Compare different boost techniques after breast conserving therapy (BCT) in terms of local and loco-regional recurrences. MATERIALS AND METHODS From 2000 to 2005, patients treated with BCT for invasive breast cancer (BC) were included. An electron boost (EB) was performed for a superficial boost-volume (less than 29 mm under the epidermis), in all other cases a brachytherapy boost (BTB) was proposed. When patients refused a BTB or it was not possible for technical reasons, a photon boost (PB) was given. The primary endpoints were local and loco-regional recurrences. Secondary endpoints were metastasis-free and overall survival. RESULTS 1379 patients were eligible for analysis. Most patients (1052) received an EB, 225 a BTB and 76 a PB. At a median follow-up of 8.8 years, 35 (2.5%) patients developed a local or loco-regional recurrence. Ten years local relapse-free rate was 97.9%. No differences between boost techniques were observed in relapse risk, metastasis-free and overall survival after multivariate analyses. CONCLUSION In women treated with BCT followed by a boost irradiation to the tumor bed, no difference in local and loco-regional recurrence, metastasis-free and overall survival was observed comparing three different boost techniques. Outcome was excellent regardless of the boost technique.
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Affiliation(s)
- Karolien Verhoeven
- Department of Radiation-Oncology, University Hospitals of Leuven, Leuven, Belgium.
| | - Isabelle Kindts
- Department of Radiation-Oncology, University Hospitals of Leuven, Leuven, Belgium
| | | | - Stéphanie Peeters
- Department of Radiation-Oncology, University Hospitals of Leuven, Leuven, Belgium
| | - Hilde Janssen
- Department of Radiation-Oncology, University Hospitals of Leuven, Leuven, Belgium
| | - Erik Van Limbergen
- Department of Radiation-Oncology, University Hospitals of Leuven, Leuven, Belgium
| | - Caroline Weltens
- Department of Radiation-Oncology, University Hospitals of Leuven, Leuven, Belgium
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Jiao Q, Wu A, Shao G, Peng H, Wang M, Ji S, Liu P, Zhang J. The latest progress in research on triple negative breast cancer (TNBC): risk factors, possible therapeutic targets and prognostic markers. J Thorac Dis 2014; 6:1329-35. [PMID: 25276378 DOI: 10.3978/j.issn.2072-1439.2014.08.13] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/28/2014] [Indexed: 12/28/2022]
Abstract
Triple negative breast cancer (TNBC) is one type of breast cancer (BC), which is defined as negative for estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (Her2). Its origins and development seem to be elusive. And for now, drugs like tamoxifen or trastuzumab which specifically apply to ER, PR or Her2 positive BC seem unforeseeable in TNBC clinical treatment. Due to its extreme malignancy, high recurrence rate and poor prognosis, a lot of work on the research of TNBC is needed. This review aims to summarize the latest findings in TNBC in risk factors, possible therapeutic targets and possible prognostic makers.
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Affiliation(s)
- Qingli Jiao
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Aiguo Wu
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Guoli Shao
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Haoyu Peng
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Mengchuan Wang
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Shufeng Ji
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Peng Liu
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
| | - Jian Zhang
- 1 Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510515, China ; 2 Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; 3 Department of Breast Oncology, Cancer Center, Sun Yat-sen University, Guangzhou 510275, China
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Akaike G, Tsunoda H, Hayashi N, Onoda T, Honda S, Suzuki K, Ohde S, Yamauchi H, Saida Y. Ultrasonography Mapping Combined With Mammography Before Breast-Conserving Surgery for Primary Breast Cancer With Microcalcifications: A Novel Approach. Clin Breast Cancer 2014; 14:352-7. [DOI: 10.1016/j.clbc.2013.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/23/2013] [Accepted: 12/23/2013] [Indexed: 12/28/2022]
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26
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Jobsen J, van der Palen J, Riemersma S, Heijmans H, Ong F, Struikmans H. Pattern of Ipsilateral Breast Tumor Recurrence After Breast-Conserving Therapy. Int J Radiat Oncol Biol Phys 2014; 89:1006-14. [DOI: 10.1016/j.ijrobp.2014.04.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/16/2014] [Accepted: 04/22/2014] [Indexed: 11/20/2022]
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Abstract
Both young patient age and breast cancer molecular subtype impact local recurrence rates and long-term prognosis for women with breast cancer. Although rates of local recurrence are consistently higher in young women and those with high-risk molecular subtypes, this risk does not appear to be overcome by more extensive surgery.
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Canavan J, Truong PT, Smith SL, Lu L, Lesperance M, Olivotto IA. Local recurrence in women with stage I breast cancer: declining rates over time in a large, population-based cohort. Int J Radiat Oncol Biol Phys 2014; 88:80-6. [PMID: 24331653 DOI: 10.1016/j.ijrobp.2013.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate whether local recurrence (LR) risk has changed over time among women with stage I breast cancer treated with breast-conserving therapy. METHODS AND MATERIALS Subjects were 5974 women aged ≥50 years diagnosis with pT1N0 breast cancer from 1989 to 2006, treated with breast-conserving surgery and radiation therapy. Clinicopathologic characteristics, treatment, and LR outcomes were compared among 4 cohorts stratified by year of diagnosis: 1989 to 1993 (n=1077), 1994 to 1998 (n=1633), 1999 to 2002 (n=1622), and 2003 to 2006 (n=1642). Multivariable analysis was performed, with year of diagnosis as a continuous variable. RESULTS Median follow-up time was 8.6 years. Among patients diagnosed in 1989 to 1993, 1994 to 1998, 1999 to 2002, and 2003 to 2006, the proportions of grade 1 tumors increased (16% vs 29% vs 40% vs 39%, respectively, P<.001). Surgical margin clearance rates increased from 82% to 93% to 95% and 88%, respectively (P<.001). Over time, the proportions of unknown estrogen receptor (ER) status decreased (29% vs 10% vs 1.2% vs 0.5%, respectively, P<.001), whereas ER-positive tumors increased (56% vs 77% vs 86% vs 86%, respectively, P<.001). Hormone therapy use increased (23% vs 23% vs 62% vs 73%, respectively, P<.001), and chemotherapy use increased (2% vs 5% vs 10% vs 13%, respectively, P<.001). The 5-year cumulative incidence rates of LR over the 4 time periods were 2.8% vs 1.7% vs 0.9% vs 0.8%, respectively (Gray's test, P<.001). On competing risk multivariable analysis, year of diagnosis was significantly associated with decreased LR (hazard ratio, 0.92 per year, P=.0003). Relative to grade 1 histology, grades 2, 3, and unknown were associated with increased LR. Hormone therapy use was associated with reduced LR. CONCLUSION Significant changes in the multimodality management of stage I breast cancer have occurred over the past 2 decades. More favorable-risk tumors were diagnosed, and margin clearance and systemic therapy use increased. These changes contributed to the observed declining LR rates among patients treated with breast-conserving therapy.
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Affiliation(s)
- Joycelin Canavan
- Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia, Canada.
| | - Pauline T Truong
- Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia, Canada
| | - Sally L Smith
- Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia, Canada
| | - Linghong Lu
- Department of Mathematics and Statistics, University of Victoria, British Columbia, Canada
| | - Mary Lesperance
- Department of Mathematics and Statistics, University of Victoria, British Columbia, Canada
| | - Ivo A Olivotto
- Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary
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Li S, Liu J, Yang Y, Zeng Y, Deng H, Jia H, Li Q, Feng H, Li Y, Song E, Liu Q, Su F. Impact of atypical hyperplasia at margins of breast-conserving surgery on the recurrence of breast cancer. J Cancer Res Clin Oncol 2014; 140:599-605. [PMID: 24509653 DOI: 10.1007/s00432-014-1597-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Atypical hyperplasia (AH) is associated with a relatively higher risk of subsequent development of cancer. It remains controversial whether it is necessary to re-excise AH found at surgical margins during breast-conserving surgery (BCS). The aim of this study was to determine the impact of atypical ductal/lobular hyperplasia found at the margins during BCS on the prognosis of early-stage breast cancer patients. METHODS A retrospective analysis comparing patients with AH and receiving no further surgical treatment (n = 233) to those without AH at the margins during BCS (n = 158) was performed. RESULTS At a median follow-up of 76 months, the 5- and 8-year rates of ipsilateral breast tumor recurrence (IBTR) were 3.26 and 8.79% for women with AH and 2.56 and 8.95% for women without AH, respectively. There were no significant differences between the two groups in terms of IBTR (p = 0.803), distant-metastasis-free survival (DMFS) (p = 0.749), or overall survival (OS) (p = 0.165). Moreover, no significant differences were found in IBTR, DMFS, or OS between patients with severe atypical hyperplasia (n = 86) and those without AH (n = 158) (p = 0.81, 0.82, and 0.78, respectively). Additionally, young women or those with ductal carcinoma in situ or triple-negative breast cancer with AH involving margins did not have a higher IBTR rate when compared to similar patients without AH. CONCLUSIONS This study suggests that AH found at the margins during BCS does not increase the risk of subsequently developing an IBTR. There is not enough evidence for re-excision of AH found at the margins during BCS in patients with early-stage breast cancer.
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Pilewskie M, Morrow M. The Effect of Margin Width on Local Recurrence of Triple Negative Breast Cancer. Curr Breast Cancer Rep 2014. [DOI: 10.1007/s12609-013-0132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pilewskie M, Ho A, Orell E, Stempel M, Chen Y, Eaton A, Patil S, Morrow M. Effect of margin width on local recurrence in triple-negative breast cancer patients treated with breast-conserving therapy. Ann Surg Oncol 2013; 21:1209-14. [PMID: 24327132 DOI: 10.1245/s10434-013-3416-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effect of increasing negative margin width after breast-conserving therapy (BCT) on local recurrence (LR) is controversial. LR rates vary by subtype, with the highest rates seen in triple-negative breast cancer (TNBC). This study examined LR rates in relationship to margin width in TNBC treated with BCT. METHODS Women with TNBC who underwent BCT between 1999 and 2009 were identified. Margins were defined as positive (ink on tumor), 0.1-2.0, and 2 mm. Patients with positive margins were excluded. Statistical comparisons were by t test, Fisher's exact test, and Wilcoxon rank sum test. Cumulative incidence of LR was compared by competing-risks methodology. RESULTS Of 535 cancers, 71 had margins ≤2 mm and 464 had margins >2 mm. At a median follow-up of 84 months (range 8-165 months), there were 37 local, 18 regional, and 77 distant recurrences or deaths as first events. Ten patients had a locoregional recurrence before planned radiotherapy and were excluded from cumulative incidence analyses. The cumulative incidence of LR at 60 months for margins ≤2 mm was 4.7 % (95 % confidence interval 0-10.0) and for >2 mm was 3.7 % (1.8, 5.5) (p = 0.11). After controlling for chemotherapy and tumor size, there was no difference in LR between the two margin groups (p = 0.06). A difference in the risk of distant recurrence or death was not observed (p = 0.53). CONCLUSIONS Margin width of >2 mm was not associated with reduced LR rates. These data support a negative margin definition of no ink on tumor, even in this high-risk TNBC cohort.
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Affiliation(s)
- Melissa Pilewskie
- Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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McLaughlin S, Mittendorf EA, Bleicher RJ, McCready DR, King TA. The 2013 Society of Surgical Oncology Susan G. Komen for the Cure Symposium: MRI in Breast Cancer: Where Are We Now? Ann Surg Oncol 2013; 21:28-36. [DOI: 10.1245/s10434-013-3307-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Indexed: 11/18/2022]
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