Jungeun Choi1, Alison Laws2,3,4, Jiani Hu5, William Barry5, Mehra Golshan2,3, Tari King6,7. 1. Department of Surgery, Yeungnam University College of Medicine, Gyeongsan, South Korea. 2. Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. 3. Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. 4. Department of Surgery, University of Calgary, Calgary, AB, Canada. 5. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA. 6. Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. tking7@bwh.harvard.edu. 7. Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. tking7@bwh.harvard.edu.
Abstract
BACKGROUND: Optimal margin width for breast-conserving therapy (BCT) after neoadjuvant chemotherapy (NAC) is unknown. We sought to determine the impact of margin width on local recurrence and survival after NAC and BCT. METHODS: Patients treated with NAC and BCT for stage I-III breast cancer from 2002 to 2014 were identified. Multivariate Cox regression was performed to determine the relationship between margin width and local recurrence free-survival (LRFS), disease-free survival (DFS), and overall survival (OS). RESULTS: A total of 382 patients were included. Median age was 51 years [range 22-79], median tumor size 3.0 cm [range 0.6-11.0], and receptor subtypes included 144 (37.7%) HR-/HER2-, 47 (12.3%) HR-/HER2+, 118 (30.9%) HR+/HER2-, and 70 (18.3%) HR+/HER2+. Breast pathologic complete response (pCR) was achieved in 105 (27.5%) patients. Final margin status was positive in 8 (2.1%) patients, ≤ 1 mm in 65 (17.0%), 1.1-2 mm in 30 (7.9%), and > 2 mm in 174 (45.5%). The 5-year LRFS was 96.3% (95% CI 94.0-98.6), DFS was 85.5% (95% CI 81.8-90.7), and OS was 90.8% (95% CI 87.4-94.2). There was no difference in LRFS, DFS, or OS for margins ≤ 2 versus > 2 mm, and no difference in DFS or OS for margins ≤ 1 versus > 1 mm. HR+ subtype (p = 0.04) and pCR (p = 0.03) were correlated with favorable DFS and node negativity (p < 0.001) with favorable DFS and OS. CONCLUSIONS: In this cohort treated with NAC and BCT, there was no association between margin width and LRFS, DFS, or OS. Although further studies are needed, the excellent long-term outcomes demonstrated in patients with close (≤ 2 mm) margins following NAC suggest that a margin of "no-ink-on-tumor" may be acceptable in appropriately selected patients.
BACKGROUND: Optimal margin width for breast-conserving therapy (BCT) after neoadjuvant chemotherapy (NAC) is unknown. We sought to determine the impact of margin width on local recurrence and survival after NAC and BCT. METHODS:Patients treated with NAC and BCT for stage I-III breast cancer from 2002 to 2014 were identified. Multivariate Cox regression was performed to determine the relationship between margin width and local recurrence free-survival (LRFS), disease-free survival (DFS), and overall survival (OS). RESULTS: A total of 382 patients were included. Median age was 51 years [range 22-79], median tumor size 3.0 cm [range 0.6-11.0], and receptor subtypes included 144 (37.7%) HR-/HER2-, 47 (12.3%) HR-/HER2+, 118 (30.9%) HR+/HER2-, and 70 (18.3%) HR+/HER2+. Breast pathologic complete response (pCR) was achieved in 105 (27.5%) patients. Final margin status was positive in 8 (2.1%) patients, ≤ 1 mm in 65 (17.0%), 1.1-2 mm in 30 (7.9%), and > 2 mm in 174 (45.5%). The 5-year LRFS was 96.3% (95% CI 94.0-98.6), DFS was 85.5% (95% CI 81.8-90.7), and OS was 90.8% (95% CI 87.4-94.2). There was no difference in LRFS, DFS, or OS for margins ≤ 2 versus > 2 mm, and no difference in DFS or OS for margins ≤ 1 versus > 1 mm. HR+ subtype (p = 0.04) and pCR (p = 0.03) were correlated with favorable DFS and node negativity (p < 0.001) with favorable DFS and OS. CONCLUSIONS: In this cohort treated with NAC and BCT, there was no association between margin width and LRFS, DFS, or OS. Although further studies are needed, the excellent long-term outcomes demonstrated in patients with close (≤ 2 mm) margins following NAC suggest that a margin of "no-ink-on-tumor" may be acceptable in appropriately selected patients.
Authors: Florian Fitzal; Michael Bolliger; Daniela Dunkler; Angelika Geroldinger; Luca Gambone; Jörg Heil; Fabian Riedel; Jana de Boniface; Camilla Andre; Zoltan Matrai; Dávid Pukancsik; Regis R Paulinelli; Valerijus Ostapenko; Arvydas Burneckis; Andrej Ostapenko; Edvin Ostapenko; Francesco Meani; Yves Harder; Marta Bonollo; Andrea S M Alberti; Christoph Tausch; Bärbel Papassotiropoulos; Ruth Helfgott; Dietmar Heck; Hans-Jörg Fehrer; Markus Acko; Peter Schrenk; Elisabeth K Trapp; Pristauz-Telsnigg Gunda; Paliczek Clara; Giacomo Montagna; Mathilde Ritter; Jens-Uwe Blohmer; Sander Steffen; Laszlo Romics; Elizabeth Morrow; Katharina Lorenz; Mathias Fehr; Walter Paul Weber Journal: Ann Surg Oncol Date: 2021-10-13 Impact factor: 5.344