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J Surg Oncol. 2016 May;113(6):609-15. doi: 10.1002/jso.24224. Epub 2016 Mar 16.

Importance of margin width in breast-conserving treatment of early breast cancer.

Author information

1
Department of Breast and Endocrine Surgery, Aarhus University Hospital, Aarhus, Denmark.
2
Danish Breast Cancer Cooperative Group, Copenhagen, Denmark.
3
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
4
Department of Pathology, Aarhus University Hospital, Aarhus, Denmark.
5
Breakthrough Research Unit Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom.
6
Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
7
Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
8
Department of Surgery P, Breast Surgery Unit, Aarhus University Hospital/Randers Regional Hospital, Aarhus, Denmark.

Abstract

BACKGROUND AND METHOD:

The association between margin width and ipsilateral breast tumour recurrence (IBTR, defined as invasive recurrence) was investigated in a population-based nationwide cohort of 11,900 patients undergoing breast-conserving therapy for invasive cancer.

RESULTS:

The median follow-up was 4.9 years. The cumulative incidence of IBTR at 5 and 9 years was 2.4% and 5.9%, respectively. A final positive margin increased the risk of IBTR (HR 2.51; 95% CI 1.02-6.23). No decrease in IBTR with a wider negative margin compared to a narrow but negative margin was observed in the adjusted analysis of margin width (>0 to <2 mm vs. ≥2 to <5 mm vs. ≥5 mm (reference): HR 1.54 (CI 95% 0.81-2.93) vs. 0.95 (CI 95% 0.56-1.62) vs. 1). However, few patients had narrow margins. The factors associated with increased IBTR were young age (P < 0.001), >4 positive lymph nodes (P = 0.008) and re-excision (P = 0.003). A reduced risk of IBTR was observed with chemotherapy (P < 0.001), boost radiation (P = 0.023) and ER positivity (P < 0.001).

CONCLUSION:

An overall low rate of IBTR was observed. A final positive margin was associated with a more than twofold risk of IBTR. There was no evidence for better local control with wider margins, but the data were insufficient to show whether narrow margins were as good as wider negative margins in terms of local control. J. Surg. Oncol. 2016;113:609-615. © 2016 Wiley Periodicals, Inc.

KEYWORDS:

boost; breast conserving therapy; invasive breast cancer; ipsilateral breast tumour recurrence; surgical margin

PMID:
26991020
DOI:
10.1002/jso.24224
[Indexed for MEDLINE]

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