Beck Maximilian Heinz, Weiler Karoline Barbara Stephanie, Trelinska-Finger Anna, Blohmer Jens-Uwe
Department of Gynecology with Breast Center, Campus Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Geburtshilfe Frauenheilkd. 2024 Sep 2;84(9):837-844. doi: 10.1055/a-2374-2270. eCollection 2024 Sep.
The impact of surgical margins on the prognosis of early breast cancer remains uncertain, particularly in the context of modern treatment approaches. This study aimed to investigate whether involved margins after surgery for early breast cancer affect overall survival.
We conducted a retrospective analysis of 3767 patients who underwent surgery for primary breast cancer or carcinoma in situ between 2006 and 2022 at Charité - University Hospital Berlin. Survival analysis based on margin status and a subsequent multivariate Cox regression analysis were conducted.
With a median follow-up of 72.2 months, clear margins were achieved in 81.4% of patients (n = 3068) after primary surgery, while 16.2% (n = 610) required re-excision. Only 2.4% of patients (n = 89) had definitively involved margins. Margin involvement was more common in hormone receptor-positive disease, lobular subtype, carcinoma in situ, or locally advanced tumors, but less frequent in patients with previous neoadjuvant chemotherapy or triple-negative breast cancer. The Kaplan-Meier survival curves showed a significant separation with worse outcomes for patients with definitive R1 resections. However, the multivariate Cox regression analysis detected no statistically significant difference in overall survival based on margin status. Breast conserving surgery (HR 0.66; 95% CI 0.54-0.81) and HER2 overexpression (HR 0.65; 95% CI 0.48-0.89) were associated with improved survival.
Patients who underwent breast-conserving surgery in our study demonstrated favorable outcomes compared to patients after mastectomy. Although margin status did not significantly affect overall survival, larger multicenter studies are needed to evaluate the prognostic implications of margin involvement in breast cancer treatment in different tumor stages, tumor subtypes and local and systemic treatments.
手术切缘对早期乳腺癌预后的影响仍不确定，尤其是在现代治疗方法的背景下。本研究旨在调查早期乳腺癌手术后切缘受累是否会影响总生存期。
我们对2006年至2022年期间在柏林夏里特大学医院接受原发性乳腺癌或原位癌手术的3767例患者进行了回顾性分析。基于切缘状态进行生存分析，并随后进行多变量Cox回归分析。
中位随访72.2个月，初次手术后81.4%的患者（n = 3068）切缘阴性，而16.2%（n = 610）的患者需要再次切除。只有2.4%的患者（n = 89）切缘明确受累。切缘受累在激素受体阳性疾病、小叶亚型、原位癌或局部晚期肿瘤中更常见，但在接受过新辅助化疗的患者或三阴性乳腺癌患者中较少见。Kaplan-Meier生存曲线显示，R1切除明确的患者预后较差，生存曲线有显著分离。然而，多变量Cox回归分析未发现基于切缘状态的总生存期有统计学显著差异。保乳手术（HR 0.66；95% CI 0.54 - 0.81）和HER2过表达（HR 0.65；95% CI 0.48 - 0.89）与生存期改善相关。
与接受乳房切除术的患者相比，本研究中接受保乳手术的患者预后良好。虽然切缘状态并未显著影响总生存期，但需要更大规模的多中心研究来评估切缘受累在不同肿瘤分期、肿瘤亚型以及局部和全身治疗中的乳腺癌治疗预后意义。
