Department of Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, BC, Canada; Southern Medical Program, University of British Columbia Okanagan, Kelowna, BC, Canada.
Cancer Surveillance and Outcomes, BC Cancer Agency, Vancouver, BC, Canada.
Am J Surg. 2019 May;217(5):862-867. doi: 10.1016/j.amjsurg.2019.01.007. Epub 2019 Jan 17.
Re-operation rates following breast-conserving surgery (BCS) for early invasive breast cancer are highly variable, largely due to uncertainty regarding adequate margins. The 2014 SSO-ASTRO guidelines recommended "no ink on tumor" as adequate margins. We evaluated the effect of guideline implementation on re-operation following BCS at our regional cancer center.
Retrospective chart review was performed on records for patients with early invasive breast carcinoma undergoing BCS between February 2011 and May 2017. Time period, pathologic margin status, patient and tumor characteristics were assessed for their impact on re-operation rates.
Overall re-operation rate decreased following the guidelines release (OR 0.28, 95% C.I. 0.15-0.51, p = <0.0001), with an unadjusted decrease of 3.89%. Re-operations on both close (OR 0.17, 95% C.I. 0.07-0.40, p = <0.0001) and widely negative (OR 0.20, 95% C.I. 0.05-0.77, p = 0.02) margins decreased in the post-guidelines time period.
SSO-ASTRO margins guideline release was associated with decreased re-operation. Furthermore, re-operations rates decreased in patients with pathologically negative margins, the target population the guidelines were meant to address.
保乳手术后（BCS）早期浸润性乳腺癌的再手术率差异很大，主要是因为对充分切缘的不确定性。2014 年 SSO-ASTRO 指南建议“无肿瘤墨渍”作为充分的切缘。我们评估了我们的地区癌症中心实施指南对 BCS 后再手术的影响。
对 2011 年 2 月至 2017 年 5 月期间接受 BCS 的早期浸润性乳腺癌患者的病历进行回顾性图表审查。评估了时间、病理切缘状态、患者和肿瘤特征对再手术率的影响。
指南发布后，总体再手术率降低（OR 0.28，95%CI 0.15-0.51，p <0.0001），未经调整的降低幅度为 3.89%。在指南发布后的时期，密切（OR 0.17，95%CI 0.07-0.40，p <0.0001）和广泛阴性（OR 0.20，95%CI 0.05-0.77，p = 0.02）切缘的再手术均减少。
SSO-ASTRO 切缘指南的发布与再手术率降低有关。此外，在病理阴性切缘的患者中，再手术率降低，而这正是指南旨在解决的目标人群。
