Department of Surgery, Yeungnam University College of Medicine, Gyeongsan, South Korea.
Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Ann Surg Oncol. 2018 Nov;25(12):3541-3547. doi: 10.1245/s10434-018-6702-4. Epub 2018 Aug 20.
Optimal margin width for breast-conserving therapy (BCT) after neoadjuvant chemotherapy (NAC) is unknown. We sought to determine the impact of margin width on local recurrence and survival after NAC and BCT.
Patients treated with NAC and BCT for stage I-III breast cancer from 2002 to 2014 were identified. Multivariate Cox regression was performed to determine the relationship between margin width and local recurrence free-survival (LRFS), disease-free survival (DFS), and overall survival (OS).
A total of 382 patients were included. Median age was 51 years [range 22-79], median tumor size 3.0 cm [range 0.6-11.0], and receptor subtypes included 144 (37.7%) HR-/HER2-, 47 (12.3%) HR-/HER2+, 118 (30.9%) HR+/HER2-, and 70 (18.3%) HR+/HER2+. Breast pathologic complete response (pCR) was achieved in 105 (27.5%) patients. Final margin status was positive in 8 (2.1%) patients, ≤ 1 mm in 65 (17.0%), 1.1-2 mm in 30 (7.9%), and > 2 mm in 174 (45.5%). The 5-year LRFS was 96.3% (95% CI 94.0-98.6), DFS was 85.5% (95% CI 81.8-90.7), and OS was 90.8% (95% CI 87.4-94.2). There was no difference in LRFS, DFS, or OS for margins ≤ 2 versus > 2 mm, and no difference in DFS or OS for margins ≤ 1 versus > 1 mm. HR+ subtype (p = 0.04) and pCR (p = 0.03) were correlated with favorable DFS and node negativity (p < 0.001) with favorable DFS and OS.
In this cohort treated with NAC and BCT, there was no association between margin width and LRFS, DFS, or OS. Although further studies are needed, the excellent long-term outcomes demonstrated in patients with close (≤ 2 mm) margins following NAC suggest that a margin of "no-ink-on-tumor" may be acceptable in appropriately selected patients.
新辅助化疗（NAC）后保乳治疗（BCT）的最佳切缘宽度尚不清楚。我们旨在确定切缘宽度对 NAC 和 BCT 后局部复发和生存的影响。
从 2002 年至 2014 年，我们确定了接受 NAC 和 BCT 治疗的 I-III 期乳腺癌患者。采用多变量 Cox 回归分析来确定切缘宽度与局部无复发生存率（LRFS）、无病生存率（DFS）和总生存率（OS）之间的关系。
共纳入 382 例患者。中位年龄为 51 岁[范围 22-79]，中位肿瘤大小为 3.0cm[范围 0.6-11.0]，受体亚型包括 144 例（37.7%）HR-/HER2-、47 例（12.3%）HR-/HER2+、118 例（30.9%）HR+/HER2-和 70 例（18.3%）HR+/HER2+。105 例（27.5%）患者达到乳腺病理完全缓解（pCR）。8 例（2.1%）患者的最终切缘状态为阳性，8 例（2.1%）患者的切缘宽度为≤1mm，65 例（17.0%）患者的切缘宽度为 1.1-2mm，30 例（7.9%）患者的切缘宽度为>2mm，174 例（45.5%）患者的切缘宽度为>2mm。5 年 LRFS 为 96.3%（95%CI 94.0-98.6），DFS 为 85.5%（95%CI 81.8-90.7），OS 为 90.8%（95%CI 87.4-94.2）。切缘宽度≤2mm 与>2mm 之间的 LRFS、DFS 或 OS 无差异，切缘宽度≤1mm 与>1mm 之间的 DFS 或 OS 无差异。HR+亚型（p=0.04）和 pCR（p=0.03）与有利的 DFS 和淋巴结阴性（p<0.001）相关，DFS 和 OS 也与淋巴结阴性相关。
在接受 NAC 和 BCT 治疗的这组患者中，切缘宽度与 LRFS、DFS 或 OS 之间无相关性。尽管还需要进一步的研究，但 NAC 后切缘接近（≤2mm）的患者表现出优异的长期结果表明，在适当选择的患者中，“无肿瘤墨迹”的边缘可能是可以接受的。
