Smitt M C, Nowels K W, Zdeblick M J, Jeffrey S, Carlson R W, Stockdale F E, Goffinet D R
Department of Radiation Oncology, Stanford University Medical Center, California, USA.
Cancer. 1995 Jul 15;76(2):259-67. doi: 10.1002/1097-0142(19950715)76:2<259::aid-cncr2820760216>3.0.co;2-2.
The impact of the surgical margin status on long-term local control rates for breast cancer in women treated with lumpectomy and radiation therapy is unclear.
The records of 289 women with 303 invasive breast cancers who were treated with lumpectomy and radiation therapy from 1972 to 1992 were reviewed. The surgical margin was classified as positive (transecting the inked margin), close (less than or equal to 2 mm from the margin), negative, or indeterminate, based on the initial biopsy findings and reexcision specimens, as appropriate. Various clinical and pathologic factors were analyzed as potential prognostic factors for local recurrence in addition to the margin status, including T classification, N classification, age, histologic features, and use of adjuvant therapy. The mean follow-up was 6.25 years.
The actuarial probability of freedom from local recurrence for the entire group of patients at 5 and 10 years was 94% and 87%, respectively. The actuarial probability of local control at 10 years was 98% for those patients with negative surgical margins versus 82% for all others (P = 0.007). The local control rate at 10 years was 97% for patients who underwent reexcision and 84% for those who did not. Reexcision appears to convey a local control benefit for those patients with close, indeterminate, or positive initial margins, when negative final margins are attained (P = 0.0001). Final margin status was the most significant determinant of local recurrence rates in univariate analysis. By multivariate analysis, the final margin status and use of adjuvant chemotherapy were significant prognostic factors.
The attainment of negative surgical margins, initially or at the time of reexcision, is the most significant predictor of local control after breast-conserving treatment with lumpectomy and radiation therapy.
对于接受保乳手术及放疗的女性乳腺癌患者，手术切缘状态对长期局部控制率的影响尚不清楚。
回顾了1972年至1992年间接受保乳手术及放疗的289例患有303例浸润性乳腺癌女性患者的记录。根据初始活检结果和必要时的再次切除标本，将手术切缘分类为阳性（切断标记切缘）、切缘接近（距切缘小于或等于2毫米）、阴性或不确定。除切缘状态外，还分析了各种临床和病理因素作为局部复发的潜在预后因素，包括T分期、N分期、年龄、组织学特征和辅助治疗的使用情况。平均随访时间为6.25年。
整个患者组5年和10年无局部复发的精算概率分别为94%和87%。手术切缘阴性的患者10年局部控制的精算概率为98%，而其他所有患者为82%（P = 0.007）。接受再次切除的患者10年局部控制率为97%，未接受再次切除的患者为84%。当最终切缘为阴性时，再次切除似乎对初始切缘接近、不确定或阳性的患者有局部控制益处（P = 0.0001）。在单变量分析中，最终切缘状态是局部复发率的最显著决定因素。通过多变量分析，最终切缘状态和辅助化疗的使用是显著的预后因素。
初始或再次切除时获得阴性手术切缘，是保乳手术及放疗后局部控制的最显著预测因素。
