Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
Ann Surg Oncol. 2020 Nov;27(12):4628-4636. doi: 10.1245/s10434-020-08878-9. Epub 2020 Jul 25.
The optimal tumor-free margin definition and width following breast-conserving therapy (BCT) for early-stage invasive cancers has been evaluated in previous meta-analyses and guidelines. We performed an updated meta-analysis to assess how improvements in treatment over time have affected the impact of margins on local recurrence (LR) rates over time.
A systematic literature review identified 38 eligible studies comprising 54,502 patients treated between 1968 and 2010. Inclusion criteria included patients treated with BCT and minimum follow-up of 50 months, pathologic definitions of margin status explicitly stated, and LR data in relation to margin status. Data were pooled using a Bayesian logistic regression model to evaluate the risk of LR in relation to both margin status and study enrollment periods.
Median follow-up was 7.25 years. Absolute LR rates decreased over time for each margin width cohort, with maximum differences between negative margin groups of less than 1% for the most recent enrollment period. However, relative rates of LR between different margin groups remained stable over time.
With an additional 22,000 patients compared with the previous meta-analysis, this updated meta-analysis supports the consensus guideline of "no tumor on ink" for the majority of patients. Additionally, while concerns exist regarding a benefit with wider margins from previous studies, the analysis demonstrates the impact of margin width on LR rates has declined substantially over time, with very small differences between the narrowest and widest margin groups in the most recent cohort. Hence, older studies appear to have limited value to inform current management guidelines.
在保乳治疗（BCT）早期浸润性癌中，最佳的无肿瘤切缘定义和宽度已在之前的荟萃分析和指南中进行了评估。我们进行了一项更新的荟萃分析，以评估随着时间的推移治疗的改善如何影响切缘对局部复发（LR）率的影响。
系统文献回顾确定了 38 项符合条件的研究，共纳入 1968 年至 2010 年期间接受治疗的 54502 例患者。纳入标准包括接受 BCT 治疗且随访时间至少 50 个月、明确说明切缘状态的病理定义以及与切缘状态相关的 LR 数据的患者。使用贝叶斯逻辑回归模型汇总数据，以评估 LR 风险与切缘状态和研究入组时间的关系。
中位随访时间为 7.25 年。随着时间的推移，每个切缘宽度队列的绝对 LR 率均下降，最近入组期负切缘组之间的最大差异小于 1%。然而，不同切缘组之间的 LR 相对率在时间上保持稳定。
与之前的荟萃分析相比，本更新荟萃分析纳入了额外的 22000 例患者，支持大多数患者“无墨渍”的共识指南。此外，尽管之前的研究对更宽的切缘有获益的担忧，但分析表明，随着时间的推移，切缘宽度对 LR 率的影响已大大下降，在最近的队列中，最窄和最宽切缘组之间的差异非常小。因此，早期的研究似乎对制定当前的管理指南的价值有限。
