title: Margin status and the risk of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy.
abstract: We sought to assess whether a close surgical margin (>0 and <2 mm) after breast-conserving therapy (BCT) confers an increased risk of local recurrence (LR) compared with a widely negative margin (≥2 mm). We studied 906 women with early-stage invasive breast cancer treated with BCT between January 1998 and October 2006; 91 % received adjuvant systemic therapy. Margins were coded as: (1) widely negative (n = 729), (2) close (n = 85), or (3) close (n = 84)/positive (n = 8) but having no additional tissue to remove according to the surgeon. Cumulative incidence of LR and distant failure (DF) were calculated using the Kaplan-Meier method. Gray's competing-risk regression assessed the effect of margin status on LR and Cox proportional hazards regression assessed the effect on DF, controlling for biologic subtype, age, and number of positive lymph nodes (LNs). Three hundred seventy-seven patients (41.6 %) underwent surgical re-excision, of which 63.5 % had no residual disease. With a median follow-up of 87.5 months, the 5-year cumulative incidence of LR was 2.5 %. The 5-year cumulative incidence of LR by margin status was 2.3 % (95 % CI 1.4-3.8 %) for widely negative, 0 % for close, and 6.4 % (95 % CI 2.7-14.6 %) for no additional tissue, p = 0.3. On multivariate analysis, margin status was not associated with LR; however, triple-negative subtype (AHR 3.7; 95 % CI 1.6-8.8; p = 0.003) and increasing number of positive LNs (AHR 1.6; 95 % CI 1.1-2.3; p = 0.025) were associated. In an era of routine adjuvant systemic therapy, close surgical margins and maximally resected close/positive margins were not associated with an increased risk of LR compared to widely negative margins. Additional studies are needed to confirm this finding.
authors.affiliation: Harvard Radiation Oncology Program, Boston, MA 02215, USA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Russo
authors.forename: Nils D
authors.initials: ND
authors.lastname: Arvold
authors.forename: Andrzej
authors.initials: A
authors.lastname: Niemierko
authors.forename: Nathan
authors.initials: N
authors.lastname: Wong
authors.forename: Julia S
authors.initials: JS
authors.lastname: Wong
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Bellon
authors.forename: Rinaa S
authors.initials: RS
authors.lastname: Punglia
authors.forename: Mehra
authors.initials: M
authors.lastname: Golshan
authors.forename: Susan L
authors.initials: SL
authors.lastname: Troyan
authors.forename: Jane E
authors.initials: JE
authors.lastname: Brock
authors.forename: Jay R
authors.initials: JR
authors.lastname: Harris
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000601:surgery; D016016:Proportional Hazards Models