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高度选择的乳腺癌患者保乳术后切缘阳性率及再次切除率低:一项中国单中心经验

Low rate of positive margins and re-excision after partial mastectomy in highly selected breast cancer patients: A Chinese single-institution experience.

作者信息

Wu Siyu, Zhu Yanyan, Yang Zhaozhi, Mo Miao, Gao Hongbo, Yang Wentao, Liu Guangyu

机构信息

Department of Breast Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.

Department of General Surgery, Jinshan Hospital, Fudan University, Shanghai, P.R. China.

出版信息

Oncotarget. 2017 Feb 14;8(7):12225-12233. doi: 10.18632/oncotarget.14686.

Abstract

A recent randomized controlled trial firstly demonstrated that cavity shaving significantly decreased the rate of positive margins and re-excision among partial mastectomy (PM) patients. However, it remains unknown whether cavity shaving should be routinely applied to Chinese breast cancer patients undergoing PM. A total of 408 PM patients undergoing 410 PMs among 1796 surgically treated breast cancer patients at Fudan University Shanghai Cancer Centre from January 2015 to June 2015 were included in our study. Data were analysed with univariate or multivariate analysis. Overall, 11 of 410 cases (2.7%) had positive margins postoperatively. Moreover, only 24.6% of the cases (P<0.05) presented with ductal carcinoma in situ (DCIS), among whom 10.0% obtained positive margins. In multivariate logistic regression analysis, presence of mammographic calcifications was significantly associated with margin positivity (P<0.05, OR=6.06, 95% CI: 1.53-23.91). In conclusion, cavity shaving during PM should not be routinely performed in Chinese breast cancer patients, particularly in highly selected cases with a low prevalence of DCIS. PM patients with preoperative mammographic calcifications were more likely to have positive margins and might benefit more from cavity shaving.

摘要

最近的一项随机对照试验首次表明,在保乳手术(PM)患者中,瘤腔削除术可显著降低切缘阳性率和再次切除率。然而,对于接受PM的中国乳腺癌患者是否应常规应用瘤腔削除术,目前尚不清楚。本研究纳入了2015年1月至2015年6月在复旦大学附属肿瘤医院接受手术治疗的1796例乳腺癌患者中的408例接受PM的患者,共进行了410次PM手术。采用单因素或多因素分析方法对数据进行分析。总体而言,410例病例中有11例(2.7%)术后切缘阳性。此外,仅24.6%的病例(P<0.05)为导管原位癌(DCIS),其中10.0%切缘阳性。在多因素logistic回归分析中,乳腺钼靶钙化的存在与切缘阳性显著相关(P<0.05,OR=6.06,95%CI:1.53-23.91)。总之,在中国乳腺癌患者中,尤其是DCIS患病率较低的高度选择病例中,PM期间不应常规进行瘤腔削除术。术前乳腺钼靶有钙化的PM患者更有可能切缘阳性,可能从瘤腔削除术中获益更多。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2862/5355339/ddcf62869641/oncotarget-08-12225-g001.jpg

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