Chung A, Gangi A, Amersi F, Bose S, Zhang X, Giuliano A
Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S422-7. doi: 10.1245/s10434-015-4829-0. Epub 2015 Aug 27.
This study aimed to evaluate the impact that the release of consensus guidelines for margins in breast-conserving surgery (BCS) had on re-excision rates.
A retrospective review examined a prospectively maintained database of patients who had operable invasive breast cancer treated with BCS at the authors' institution. The patients were divided into two groups: (1) those with a diagnosis determined from 1 July 2011 to 31 July 2013 (before release of the guidelines) and (2) those with a diagnosis determined from 1 February 2014 to 31 July 2014 (after release of the guidelines). The groups were evaluated with respect to patient and tumor characteristics, re-excision rates, and reasons for re-excision.
A total of 846 cases of BCS were managed: 597 in group 1 and 249 in group 2. Re-excision rates were significantly reduced after release of the consensus guidelines (p = 0.03). Re-excisions were performed for 115 (19 %) of 597 patients in group 1 and 32 (13 %) of 249 patients in group 2. After release of the guidelines, re-excisions were performed for positive margins, as defined by the consensus statement, in 25 (78 %) of 32 cases. The two groups did not differ significantly in terms of age, tumor size, grade, nodal status, estrogen receptor status, progesterone receptor status, or human epidermal growth factor receptor 2 status. Group 1 had more tumors of mixed ductal and lobular histology than group 2, and group 2 had more lobular tumors than group 1 (p = 0.02).
The consensus guidelines on margins for BCS were applied for 78 % of the patients who underwent re-excision and resulted in a significant reduction in re-excision rates.
本研究旨在评估保乳手术（BCS）切缘共识指南的发布对再次切除率的影响。
一项回顾性研究对作者所在机构接受BCS治疗的可手术浸润性乳腺癌患者的前瞻性维护数据库进行了检查。患者分为两组：（1）诊断时间为2011年7月1日至2013年7月31日（指南发布前）的患者；（2）诊断时间为2014年2月1日至2014年7月31日（指南发布后）的患者。对两组患者的患者和肿瘤特征、再次切除率及再次切除原因进行了评估。
共处理了846例BCS病例：第1组597例，第2组249例。共识指南发布后，再次切除率显著降低（p = 0.03）。第1组597例患者中有115例（19%）进行了再次切除，第2组249例患者中有32例（13%）进行了再次切除。指南发布后，按照共识声明定义，32例中有25例（78%）因切缘阳性进行了再次切除。两组在年龄、肿瘤大小、分级、淋巴结状态、雌激素受体状态、孕激素受体状态或人表皮生长因子受体2状态方面无显著差异。第1组混合导管和小叶组织学类型的肿瘤比第2组多，第2组小叶肿瘤比第1组多（p = 0.02）。
BCS切缘共识指南应用于78%接受再次切除的患者，使再次切除率显著降低。
