Cheun Jong-Ho, Kim Hong-Kyu, Lee Han-Byoel, Han Wonshik, Moon Hyeong-Gon
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
J Breast Cancer. 2023 Dec;26(6):558-571. doi: 10.4048/jbc.2023.26.e46. Epub 2023 Oct 17.
Patients with breast cancer with positive lumpectomy margins have a two-fold increased risk of ipsilateral breast tumor recurrence (IBTR). This can be the result of either technically incomplete resection or the biological characteristics of the tumor that lead to a positive margin. We hypothesized that if achieving negative margins by re-excision nullifies the IBTR risk, then the increased risk is mainly attributed to the technical incompleteness of the initial surgeries. Thus, we investigated IBTR rates in patients with breast cancer who achieved clear margins after re-excision.
We retrospectively reviewed patients who underwent breast lumpectomy for invasive breast cancer between 2004 and 2018 at a single institution, and investigated IBTR events.
Among 5,598 patients, 793 achieved clear margins after re-excision of their initial positive margins. During the median follow-up period of 76.4 months, 121 (2.2%) patients experienced IBTR. Patients who underwent re-excision to achieve negative margin experienced significantly higher IBTR rates compared to those achieving clear margin at first lumpectomy (10-year IBTR rate: 5.3% vs. 2.6% [25 vs. 84 events]; unadjusted = 0.031, hazard ratio, 1.61, 95% confidence interval [CI], 1.04-2.48; adjusted = 0.030, hazard ratio, 1.69, 95% CI, 1.05-2.72). This difference was more evident in patients aged < 50 years and those with delayed IBTR. Additionally, no statistically significant differences were observed in the spatial distribution of IBTR locations.
Patients who underwent re-excision for initial positive margins had an increased risk of IBTR, even after achieving a final negative margin, compared to patients with negative margins initially. This increased risk of IBTR is mostly observed in young patients and delayed cases.
乳房肿瘤切除切缘阳性的乳腺癌患者同侧乳腺肿瘤复发（IBTR）风险增加两倍。这可能是手术技术上切除不完全或肿瘤生物学特性导致切缘阳性的结果。我们假设，如果通过再次切除实现阴性切缘可消除IBTR风险，那么风险增加主要归因于初次手术的技术不完整性。因此，我们调查了再次切除后切缘清晰的乳腺癌患者的IBTR发生率。
我们回顾性分析了2004年至2018年在一家机构接受浸润性乳腺癌乳房肿瘤切除术的患者，并调查了IBTR事件。
在5598例患者中，793例在初次阳性切缘再次切除后获得了清晰切缘。在中位随访期76.4个月内，121例（2.2%）患者发生了IBTR。与初次乳房肿瘤切除时切缘清晰的患者相比，通过再次切除实现阴性切缘的患者IBTR发生率显著更高（10年IBTR发生率：5.3%对2.6%[25例对84例]；未调整P=0.031，风险比，1.61，95%置信区间[CI]，1.04 - 2.48；调整后P=0.030，风险比，1.69，95%CI，1.05 - 2.72）。这种差异在年龄<50岁的患者和IBTR延迟发生的患者中更为明显。此外，在IBTR发生部位的空间分布上未观察到统计学显著差异。
与初始切缘阴性的患者相比，因初始切缘阳性而接受再次切除的患者即使最终实现了阴性切缘，其IBTR风险仍增加。这种IBTR风险增加在年轻患者和延迟病例中最为常见。
