Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2013 Dec;20(13):4103-12. doi: 10.1245/s10434-013-3194-0. Epub 2013 Aug 23.
The impact of close margins in patients with ductal carcinoma-in situ (DCIS) treated with mastectomy is unclear; however, this finding may lead to a recommendation for postmastectomy radiotherapy (PMRT). We sought to determine the incidence and consequences of close margins in patients with DCIS treated with mastectomy.
The records of 810 patients with DCIS treated with mastectomy from 1996 through 2009 were reviewed. Clinical and pathologic factors were analyzed with respect to final margin status. Median follow-up was 6.3 years.
Overall, 94 patients (11.7 %) had close margins (positive, n = 5; negative but ≤1 mm, n = 54; 1.1-2.9 mm, n = 35). Independent risk factors for close margins included multicentricity, pathologic lesion size ≥1.5 cm, and necrosis, but not age, use of skin-sparing mastectomy, or immediate reconstruction (p > 0.05). Seven patients received PMRT, and none had a locoregional recurrence (LRR). Among the remaining 803 patients, the 10-year LRR rate was 1 % (5.0 % for margins ≤1 mm, 3.6 % for margins 1.1-2.9 mm, and 0.7 % for margins ≥3 mm [p < 0.001]). The 10-year rate of contralateral breast cancer was 6.4 %. On multivariate analysis, close margins was the only independent predictor of LRR (p = 0.005).
Close margins occur in a minority of patients undergoing mastectomy for DCIS and is the only independent risk factor for LRR. As the LRR rate in patients with close margins is low and less than the rate of contralateral breast cancer, PMRT is not warranted except for patients with multiple close/positive margins that cannot be surgically excised.
在接受乳房切除术治疗的导管原位癌（DCIS）患者中，切缘接近的影响尚不清楚；然而，这一发现可能导致推荐行乳房切除术后放疗（PMRT）。我们旨在确定接受乳房切除术治疗的 DCIS 患者中切缘接近的发生率和后果。
回顾了 1996 年至 2009 年期间接受乳房切除术治疗的 810 例 DCIS 患者的记录。分析了临床和病理因素与最终切缘状态的关系。中位随访时间为 6.3 年。
总体而言，94 例（11.7%）患者切缘接近（阳性，n=5；阴性但≤1mm，n=54；1.1-2.9mm，n=35）。切缘接近的独立危险因素包括多中心性、病变大小≥1.5cm 和坏死，但与年龄、是否采用保留皮肤的乳房切除术或即刻重建无关（p>0.05）。7 例患者接受了 PMRT，无局部区域复发（LRR）。在其余 803 例患者中，10 年 LRR 率为 1%（切缘≤1mm 为 5.0%，切缘 1.1-2.9mm 为 3.6%，切缘≥3mm 为 0.7%[p<0.001]）。10 年对侧乳腺癌发生率为 6.4%。多变量分析显示，切缘接近是 LRR 的唯一独立预测因素（p=0.005）。
在接受乳房切除术治疗的 DCIS 患者中，切缘接近的情况较为少见，是 LRR 的唯一独立危险因素。由于切缘接近患者的 LRR 率较低，且低于对侧乳腺癌的发生率，除非存在多处无法手术切除的切缘接近/阳性，否则不推荐行 PMRT。
