Influence of margin status on outcomes in lobular carcinoma: Experience of the European institute of oncology

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Abstract

Objective: We analyzed 382 patients with pure lobular carcinoma treated up to 2002 with sufficient follow-up to draw prognostic conclusions, all treated by conservative surgery. Our aim was to evaluate the influence of margin status on outcomes with a view assessing the appropriateness of conservative surgery in this breast cancer subtype. Methods: We assessed locoregional relapse, distant metastasis, contralateral breast cancer, breast cancer-related event free survival, disease-free survival and overall survival according to margin status categorized as at least 10 mm versus less than 10 mm (usually considered negative). Results:: The proportions of patients with less than 10 mm margins varied significantly with age (P = 0.02), menopausal status (P = 0.006), and tumor size (P = 0.02) but no other characteristic was significantly related to margin status. As regards unfavorable events during follow-up, none differed significantly between at least 10 mm and less than 10 mm margin groups. In particular, there were 11 (3.7%) local relapses in the same quadrant in at least 10 mm margin group compared to 4 (4.6%) in the less than 10 mm margin group, and 7 (2.4%) ipsilateral breast cancers in the 10 mm or more margin group but none in the less than 10 mm group. These findings indicate that minimal residual disease as evidenced by margins less than 10 mm is eradicated by radiotherapy (backed up in selected cases by reexcision, which in this series was always conservative). The rate of contralateral breast cancer was low at 2.9% indicating that prophylactic contralateral mastectomy is not justified. Conclusions: We conclude that the surgical approach and criteria for adjuvant hormonal and systemic treatment in lobular carcinoma should be the same as for ductal carcinoma, provided that adequate preoperative investigations exclude extensive multifocal and contralateral disease.

Original languageEnglish
Pages (from-to)580-584
Number of pages5
JournalAnnals of Surgery
Volume253
Issue number3
DOIs
Publication statusPublished - Mar 2011

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Lobular Carcinoma
Breast Neoplasms
Disease-Free Survival
Recurrence
Ductal Carcinoma
Residual Neoplasm
Radiotherapy
Neoplasm Metastasis
Survival
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

@article{a010048104d84ef4a66989db849c850b,
title = "Influence of margin status on outcomes in lobular carcinoma: Experience of the European institute of oncology",
abstract = "Objective: We analyzed 382 patients with pure lobular carcinoma treated up to 2002 with sufficient follow-up to draw prognostic conclusions, all treated by conservative surgery. Our aim was to evaluate the influence of margin status on outcomes with a view assessing the appropriateness of conservative surgery in this breast cancer subtype. Methods: We assessed locoregional relapse, distant metastasis, contralateral breast cancer, breast cancer-related event free survival, disease-free survival and overall survival according to margin status categorized as at least 10 mm versus less than 10 mm (usually considered negative). Results:: The proportions of patients with less than 10 mm margins varied significantly with age (P = 0.02), menopausal status (P = 0.006), and tumor size (P = 0.02) but no other characteristic was significantly related to margin status. As regards unfavorable events during follow-up, none differed significantly between at least 10 mm and less than 10 mm margin groups. In particular, there were 11 (3.7{\%}) local relapses in the same quadrant in at least 10 mm margin group compared to 4 (4.6{\%}) in the less than 10 mm margin group, and 7 (2.4{\%}) ipsilateral breast cancers in the 10 mm or more margin group but none in the less than 10 mm group. These findings indicate that minimal residual disease as evidenced by margins less than 10 mm is eradicated by radiotherapy (backed up in selected cases by reexcision, which in this series was always conservative). The rate of contralateral breast cancer was low at 2.9{\%} indicating that prophylactic contralateral mastectomy is not justified. Conclusions: We conclude that the surgical approach and criteria for adjuvant hormonal and systemic treatment in lobular carcinoma should be the same as for ductal carcinoma, provided that adequate preoperative investigations exclude extensive multifocal and contralateral disease.",
author = "Viviana Galimberti and Patrick Maisonneuve and Nicole Rotmensz and Giuseppe Viale and Claudia Sangalli and Manuela Sargenti and Fabricio Brenelli and Oreste Gentilini and Mattia Intra and Fabio Bassi and Alberto Luini and Stefano Zurrida and Paolo Veronesi and Marco Colleoni and Umberto Veronesi",
year = "2011",
month = "3",
doi = "10.1097/SLA.0b013e31820d9a81",
language = "English",
volume = "253",
pages = "580--584",
journal = "Annals of Surgery",
issn = "0003-4932",
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TY - JOUR

T1 - Influence of margin status on outcomes in lobular carcinoma

T2 - Experience of the European institute of oncology

AU - Galimberti, Viviana

AU - Maisonneuve, Patrick

AU - Rotmensz, Nicole

AU - Viale, Giuseppe

AU - Sangalli, Claudia

AU - Sargenti, Manuela

AU - Brenelli, Fabricio

AU - Gentilini, Oreste

AU - Intra, Mattia

AU - Bassi, Fabio

AU - Luini, Alberto

AU - Zurrida, Stefano

AU - Veronesi, Paolo

AU - Colleoni, Marco

AU - Veronesi, Umberto

PY - 2011/3

Y1 - 2011/3

N2 - Objective: We analyzed 382 patients with pure lobular carcinoma treated up to 2002 with sufficient follow-up to draw prognostic conclusions, all treated by conservative surgery. Our aim was to evaluate the influence of margin status on outcomes with a view assessing the appropriateness of conservative surgery in this breast cancer subtype. Methods: We assessed locoregional relapse, distant metastasis, contralateral breast cancer, breast cancer-related event free survival, disease-free survival and overall survival according to margin status categorized as at least 10 mm versus less than 10 mm (usually considered negative). Results:: The proportions of patients with less than 10 mm margins varied significantly with age (P = 0.02), menopausal status (P = 0.006), and tumor size (P = 0.02) but no other characteristic was significantly related to margin status. As regards unfavorable events during follow-up, none differed significantly between at least 10 mm and less than 10 mm margin groups. In particular, there were 11 (3.7%) local relapses in the same quadrant in at least 10 mm margin group compared to 4 (4.6%) in the less than 10 mm margin group, and 7 (2.4%) ipsilateral breast cancers in the 10 mm or more margin group but none in the less than 10 mm group. These findings indicate that minimal residual disease as evidenced by margins less than 10 mm is eradicated by radiotherapy (backed up in selected cases by reexcision, which in this series was always conservative). The rate of contralateral breast cancer was low at 2.9% indicating that prophylactic contralateral mastectomy is not justified. Conclusions: We conclude that the surgical approach and criteria for adjuvant hormonal and systemic treatment in lobular carcinoma should be the same as for ductal carcinoma, provided that adequate preoperative investigations exclude extensive multifocal and contralateral disease.

AB - Objective: We analyzed 382 patients with pure lobular carcinoma treated up to 2002 with sufficient follow-up to draw prognostic conclusions, all treated by conservative surgery. Our aim was to evaluate the influence of margin status on outcomes with a view assessing the appropriateness of conservative surgery in this breast cancer subtype. Methods: We assessed locoregional relapse, distant metastasis, contralateral breast cancer, breast cancer-related event free survival, disease-free survival and overall survival according to margin status categorized as at least 10 mm versus less than 10 mm (usually considered negative). Results:: The proportions of patients with less than 10 mm margins varied significantly with age (P = 0.02), menopausal status (P = 0.006), and tumor size (P = 0.02) but no other characteristic was significantly related to margin status. As regards unfavorable events during follow-up, none differed significantly between at least 10 mm and less than 10 mm margin groups. In particular, there were 11 (3.7%) local relapses in the same quadrant in at least 10 mm margin group compared to 4 (4.6%) in the less than 10 mm margin group, and 7 (2.4%) ipsilateral breast cancers in the 10 mm or more margin group but none in the less than 10 mm group. These findings indicate that minimal residual disease as evidenced by margins less than 10 mm is eradicated by radiotherapy (backed up in selected cases by reexcision, which in this series was always conservative). The rate of contralateral breast cancer was low at 2.9% indicating that prophylactic contralateral mastectomy is not justified. Conclusions: We conclude that the surgical approach and criteria for adjuvant hormonal and systemic treatment in lobular carcinoma should be the same as for ductal carcinoma, provided that adequate preoperative investigations exclude extensive multifocal and contralateral disease.

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U2 - 10.1097/SLA.0b013e31820d9a81

DO - 10.1097/SLA.0b013e31820d9a81

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JO - Annals of Surgery

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SN - 0003-4932

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