title: Risk factors for positive margins in conservative surgery for breast cancer after neoadjuvant chemotherapy.
abstract: BACKGROUND
  Breast conservative surgery after neoadjuvant chemotherapy intends to remove any residual tumor with negative margins. The purpose of this study was to analyze the preoperative clinical-pathological factors influencing the margin status after conservative surgery in breast cancer patients receiving neoadjuvant chemotherapy.
  
  
  METHODS
  A retrospective study of 91 breast cancer patients undergoing neoadjuvant chemotherapy (92 breast lesions) during the period 2006 to 2013. A Cox regression analysis to identify baseline tumor characteristics associated with positive margins after breast conservative surgery was performed.
  
  
  RESULTS
  Of all cases, 71 tumors were initially treated with conservative surgery after neoadjuvant chemotherapy. Pathologic exam revealed positive margins in 16 of the 71 cases (22.5%). The incidence of positive margins was significantly higher in cancers with initial size >5cm (P=.021), in cancers with low tumor grade (P=.031), and in patients with hormone receptor-positive cancer (P=.006). After a median follow-up of 45.2 months, 7 patients of the 71 treated with conservative surgery had disease recurrence (9.8%). There was no significant difference in terms of disease-free survival according to the margin status (P=.596).
  
  
  CONCLUSIONS
  A baseline tumor size >5cm, low tumor grade and hormone receptor-positive status increase the risk for surgical margin involvement in breast conservative surgery after neoadjuvant chemotherapy.
authors.affiliation: Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bouzón
authors.affiliation: Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España. Electronic address: baceneb@sergas.es.
authors.forename: Benigno
authors.initials: B
authors.lastname: Acea
authors.affiliation: Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España.
authors.forename: Alejandra
authors.initials: A
authors.lastname: García
authors.affiliation: Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España.
authors.forename: Ángela
authors.initials: Á
authors.lastname: Iglesias
authors.affiliation: Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Mosquera
authors.affiliation: Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España.
authors.forename: Paz
authors.initials: P
authors.lastname: Santiago
authors.affiliation: Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España.
authors.forename: Teresa
authors.initials: T
authors.lastname: Seoane
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D000072700:Conservative Treatment; D005260:Female; D006801:Humans; D000072662:Margins of Excision; D008408:Mastectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Breast cancer; Cirugía conservadora; Conservative surgery; Cáncer de mama; Márgenes positivos; Neoadjuvant chemotherapy; Positive margins; Quimioterapia neoadyuvante