University of Alabama at Birmingham, Department of Radiation Oncology, USA.
Alliance Cancer Care in Huntsville, Alabama, USA.
Breast. 2021 Dec;60:86-89. doi: 10.1016/j.breast.2021.08.012. Epub 2021 Sep 2.
Previous studies suggest the rate of positive surgical margin (PSM) after lumpectomy for breast cancer is approximately 20 %. The risk of PSM at time of resection is often a source of fear for patients, driving some to elect to undergo mastectomy. This study describes rates and predictors of positive margins for invasive breast cancers in the National Cancer Database (NCDB).
From 2004 to 2013, patients with non-metastatic invasive breast cancers who underwent breast conservation surgery were identified from the NCDB. Patients' demographic, clinical, and facility of treatment characteristics were collected and compared. Per SSO-ASTRO-ASCO criteria, margin negative is defined as no gross or microscopic disease (i.e. no tumor on ink). Bivariate tests and multivariate logistic regression were conducted to identify independent predictors of patients with PSM at the time of resection.
A total of 707,798 patients were identified with non-metastatic invasive breast tumors who underwent lumpectomy. Rate of PSM across the entire cohort was 5.02 %. Over time, the rate of PSM decreased significantly from 6.54 % in 2004 to 3.91 % in 2013 (p < 0.001). Pure lobular histology predicted for the highest rate of PSM compared with IDC (8.63 vs 4.55 %; p < 0.001). In adjusted analysis, high grade, non-ductal histology and HER2 amplification were significantly associated with PSM with breast conservation while estrogen and progesterone status were not.
This study demonstrates a 5 % risk of PSM at time of breast conservation surgery using a large, modern national database. Patients with invasive lobular and mixed histology have a nearly two-fold risk of PSM compared to invasive ductal cancers. These results provide important data points to help appropriately counsel patients regarding the risk of PSM.
先前的研究表明，乳腺癌保乳手术后的阳性切缘（PSM）率约为 20%。切除时的 PSM 风险常常令患者感到恐惧，促使一些患者选择接受乳房切除术。本研究描述了国家癌症数据库（NCDB）中浸润性乳腺癌的 PSM 发生率和预测因素。
从 2004 年到 2013 年，从 NCDB 中确定了接受保乳手术的非转移性浸润性乳腺癌患者。收集并比较了患者的人口统计学、临床和治疗机构特征。根据 SSO-ASTRO-ASCO 标准，切缘阴性定义为无肉眼或显微镜下疾病（即无墨迹肿瘤）。进行了双变量检验和多变量逻辑回归分析，以确定在切除时存在 PSM 的患者的独立预测因素。
共确定了 707798 例患有非转移性浸润性乳腺肿瘤且接受保乳手术的患者。整个队列的 PSM 率为 5.02%。随着时间的推移，PSM 的发生率从 2004 年的 6.54%显著下降至 2013 年的 3.91%（p<0.001）。与 IDC 相比，纯小叶组织学预测 PSM 发生率最高，为 8.63%比 4.55%（p<0.001）。在调整分析中，高级别、非导管组织学和 HER2 扩增与保乳时的 PSM 显著相关，而雌激素和孕激素状态则没有。
本研究使用大型现代国家数据库显示，保乳手术后的 PSM 风险为 5%。与浸润性导管癌相比，浸润性小叶和混合组织学的患者 PSM 风险增加近两倍。这些结果为适当告知患者 PSM 风险提供了重要数据点。
