Corsi Fabio, Sorrentino Luca, Bonzini Matteo, Bossi Daniela, Truffi Marta, Amadori Rosella, Nebuloni Manuela, Brillat Barbara, Mazzucchelli Serena
Surgery Department, Breast Unit, IRCCS Maugeri Foundation Hospital, Pavia, Italy.
Department of Biomedical and Clinical Sciences, University of Milan, "Luigi Sacco" Hospital, Milan, Italy.
Ann Surg Oncol. 2017 Jun;24(6):1516-1524. doi: 10.1245/s10434-017-5774-x. Epub 2017 Jan 23.
Currently, reinterventions for involved margins after breast-conserving surgery remain common. The aim of this study was to assess the capability of the cavity shave margins (CSM) technique to reduce positive margin rates and reoperations compared with simple lumpectomy (SL). The impact of CSM on the various biological portraits of breast cancer and costs were also investigated.
A retrospective review of 976 consecutive patients from a single center was performed; 164 patients underwent SL and 812 received CSM. All patients were treated with an oncoplastic approach. and involved margins and reoperations were compared for each group. To avoid selection bias, propensity score-matched analysis was performed before applying a logistic regression model. Main outcomes were reanalyzed for each biological portrait, and surgery and hospitalization costs for SL and CSM were compared.
Clear margins were found in 98.3% of patients in the CSM group versus 74.4% of patients in the SL group (p < 0.001). The reoperation rate was 18.9% in the SL group and 1.9% in the CSM group (p < 0.001). After propensity score-matched logistic regression, odds ratio (OR) for positive final margin status was 6.2 (95% confidence interval [CI] 2.85-13.46; p < 0.001) without CSM, while OR for reintervention was 5.46 (95% CI 2.21-13.46; p < 0.001). CSM significantly reduced positive margins and reexcisions for Luminal A, Luminal B, and triple-negative breast cancers (p < 0.001, p < 0.001, and p = 0.0137, respectively). SL had higher global costs compared with CSM: €193,630.6 versus €177,830 for 100 treated patients (p = 0.009).
CSM reduces reexcisions, mainly in luminal breast cancers, without increasing costs.
目前，保乳手术后切缘阳性的再次干预仍然很常见。本研究的目的是评估与单纯肿块切除术（SL）相比，腔隙刮除切缘（CSM）技术降低切缘阳性率和再次手术的能力。还研究了CSM对乳腺癌各种生物学特征和成本的影响。
对来自单一中心的976例连续患者进行回顾性分析；164例患者接受SL，812例接受CSM。所有患者均采用肿瘤整形方法治疗。比较每组的切缘阳性情况和再次手术情况。为避免选择偏倚，在应用逻辑回归模型之前进行倾向评分匹配分析。对每个生物学特征的主要结果进行重新分析，并比较SL和CSM的手术和住院费用。
CSM组98.3%的患者切缘阴性，而SL组为74.4%（p<0.001）。SL组的再次手术率为18.9%，CSM组为1.9%（p<0.001）。在倾向评分匹配的逻辑回归后，无CSM时最终切缘阳性状态的比值比（OR）为6.2（95%置信区间[CI]2.85-13.46；p<0.001），而再次干预的OR为5.46（95%CI 2.21-13.46；p<0.001）。CSM显著降低了Luminal A、Luminal B和三阴性乳腺癌的切缘阳性率和再次切除率（分别为p<0.001、p<0.001和p=0.0137）。与CSM相比，SL的总体成本更高：100例接受治疗的患者分别为193,630.6欧元和177,830欧元（p=0.009）。
CSM减少了再次切除，主要是在管腔型乳腺癌中，且不增加成本。
