title: Safe negative margin width in breast conservative therapy: results from a population with a high percentage of negative prognostic factors.
abstract: BACKGROUND
  There remains a controversy in the literature regarding adequate width of negative surgical margins in breast conservative therapy (BCT). It is now advocated that no tumor on an inked margin is a safe negative margin. Majority of studies on the outcomes of BCT had patients with favorable prognostic factors. Pakistani population has a high expression of unfavorable prognostic factors. The objective of this study was to determine a safe negative margin width in Pakistani population that undergoes BCT.
  
  
  METHODS
  A total of 603 patients with identifiable surgical margins underwent BCT from 1997 to 2009 in Shaukat Khanum Cancer Hospital. Patients were divided into close (≤2 mm), free (>2-10 mm), and wide (>10 mm) margin groups. Locoregional recurrence was defined as recurrence within the operated breast, ipsilateral axilla, or supraclavicular or internal mammary lymph nodes. Locoregional recurrence-free survival was calculated from the date of surgery to the date of locoregional recurrence. Five-year locoregional recurrence-free survival was determined for margin groups. Univariate and multivariate Cox proportional hazard analyses were performed to determine independent predictors of locoregional recurrence.
  
  
  RESULTS
  A total of 415 (69 %) patients were <50 years of age. There were 82 (15 %) T3/T4, 337 (56 %) poorly differentiated, and 238 (39 %) ER/PR -ve tumors. Nodal positivity was present in 314 (52 %) patients. The actual number of locoregional recurrences was 16 (12 %), 8 (3 %), and 10 (4.6 %), respectively (P = 0.002). Expected 5-year locoregional recurrence-free survival was 90, 97, and 96 %, respectively (P = 0.002). On multivariate analysis, tumor size, nodal involvement, and negative margin width were independent predictors of locoregional recurrence.
  
  
  CONCLUSIONS
  A negative margin width of 2 mm might represent an adequate negative margin width in the Pakistani population undergoing breast conservative therapy.
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan, Abubakar.hafeez@yahoo.com.
authors.forename: Abu Bakar
authors.initials: AB
authors.lastname: Bhatti
authors.forename: Amina
authors.initials: A
authors.lastname: Khan
authors.forename: Narjis
authors.initials: N
authors.lastname: Muzaffar
authors.forename: Neelam
authors.initials: N
authors.lastname: Siddiqui
authors.forename: Aamir
authors.initials: A
authors.lastname: Syed
authors.forename: Mazhar
authors.initials: M
authors.lastname: Shah
authors.forename: Awais
authors.initials: A
authors.lastname: Aamir
authors.forename: Arif
authors.initials: A
authors.lastname: Jamshed
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001940:Breast; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000556:secondary / Q000601:surgery*; D002968:Clavicle; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010154:Pakistan; D012189:Retrospective Studies; D047368:Tumor Burden; D055815:Young Adult