TY - JOUR
T1 - Margin Proximity Correlates with Local Recurrence After Mastectomy for Patients Not Receiving Adjuvant Radiotherapy
AU - Glorioso, Jaime
AU - Gonzalez Juarrero, Alexandra B.
AU - Rodysill, Brian R.
AU - Harmsen, William S.
AU - Habermann, Elizabeth B.
AU - Carter, Jodi M.
AU - Mutter, Robert W.
AU - Degnim, Amy C.
AU - Jakub, James W.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background: Although considerable evidence exists regarding margin status and reexcision for patients undergoing breast conservation therapy, few data address the impact of a close margin for patients undergoing mastectomy without postmastectomy radiotherapy. Methods: This retrospective review identified 1147 patients who underwent 1206 mastectomies with negative final margins for breast cancer from 2006 to 2010. Margin distance was analyzed as a continuous variable and dichotomized variable ((≤2 vs >2 mm). Patients undergoing adjuvant radiation therapy were excluded from the study. Uni- and multivariable analyses were used to assess the association of reexcision, proximity of the final margin, adjuvant therapy, and other clinical and pathologic factors with local recurrence (LR). Results: In 158 mastectomies (13.1%), a reexcision was performed for a close (n = 90) or positive (n = 68) margin. All but one were identified intraoperatively using frozen section analysis. The reexcision rates for skin- and nipple-sparing mastectomy (SSM/NSM) were higher than for simple mastectomy (SM) (19.8 vs 9.3%; p < 0.001). The overall 5-year risk for an LR was 3.8%. The risk was 3.1% for a margin greater than 2 mm and 11.2% for a margin of 2 mm or smaller. In the multivariable model, proximity of the final margin measured as a continuous variable was found to be a significant risk factor for LR (p = 0.009), whereas adjuvant endocrine therapy was found to be protective (p = 0.03). Intraoperative reexcision was not significant in the multivariable model (p = 0.23). Conclusions: For patients undergoing mastectomy for breast cancer, a wider final margin correlated with a reduced risk for LR. The rates for LR were similar between SSM/NSM and SM despite higher rates of intraoperative reexcision for SSM/NSM.
AB - Background: Although considerable evidence exists regarding margin status and reexcision for patients undergoing breast conservation therapy, few data address the impact of a close margin for patients undergoing mastectomy without postmastectomy radiotherapy. Methods: This retrospective review identified 1147 patients who underwent 1206 mastectomies with negative final margins for breast cancer from 2006 to 2010. Margin distance was analyzed as a continuous variable and dichotomized variable ((≤2 vs >2 mm). Patients undergoing adjuvant radiation therapy were excluded from the study. Uni- and multivariable analyses were used to assess the association of reexcision, proximity of the final margin, adjuvant therapy, and other clinical and pathologic factors with local recurrence (LR). Results: In 158 mastectomies (13.1%), a reexcision was performed for a close (n = 90) or positive (n = 68) margin. All but one were identified intraoperatively using frozen section analysis. The reexcision rates for skin- and nipple-sparing mastectomy (SSM/NSM) were higher than for simple mastectomy (SM) (19.8 vs 9.3%; p < 0.001). The overall 5-year risk for an LR was 3.8%. The risk was 3.1% for a margin greater than 2 mm and 11.2% for a margin of 2 mm or smaller. In the multivariable model, proximity of the final margin measured as a continuous variable was found to be a significant risk factor for LR (p = 0.009), whereas adjuvant endocrine therapy was found to be protective (p = 0.03). Intraoperative reexcision was not significant in the multivariable model (p = 0.23). Conclusions: For patients undergoing mastectomy for breast cancer, a wider final margin correlated with a reduced risk for LR. The rates for LR were similar between SSM/NSM and SM despite higher rates of intraoperative reexcision for SSM/NSM.
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U2 - 10.1245/s10434-017-5968-2
DO - 10.1245/s10434-017-5968-2
M3 - Article
C2 - 28681156
AN - SCOPUS:85021822883
SN - 1068-9265
VL - 24
SP - 3148
EP - 3156
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 11
ER -