Involved margins after lumpectomy for breast cancer: Always to be re-excised?

Luca Sorrentino, Manuela Agozzino, Sara Albasini, Daniela Bossi, Serena Mazzucchelli, R. Vanna, Ourania Papadopoulou, L. Villani, F. Corsi

Research output: Contribution to journalArticle

Abstract

Background: The oncologic benefit of upfront re-excision of involved margins after breast-conserving surgery in the context of current multimodal clinical management of breast cancer is unclear. The aim of the present study was to assess the 5-years locoregional recurrence (LRR)-free and distant metastases (DM)-free survival probabilities in patients not undergoing re-excision of positive margins after lumpectomy for breast cancer. Methods: A cohort of 104 patients with positive margins not undergoing re-excision was matched by propensity score with a cohort of 2006 control patients with clear margins after breast-conserving surgery, treated between 2008 and 2018. A multivariate survival analysis was performed accounting for all variables related to LRR and DM, including adjuvant treatments. Results: After adjusting for potential confounders, avoiding to re-excise a positive margin after lumpectomy had no effect on 5-years LRR-free survival probability (HR 0.98, 95%CI 0.36–2.67, p = 0.96) or 5-years DM-free survival probability (HR 0.37, 95%CI 0.08–1.61, p = 0.18). No correlation was found between occurrence of LRR and number of involved margins (HR 1.28, 95%CI 0.10–12.4, Log-rank p = 0.83), or extension of infiltrating disease (HR 1.21, 95%CI 0.20–7.40, Log-rank p = 0.83), but a trend toward higher LRR probability was found for invasive ductal (HR 6.92, 95%CI 0.7–68.8, Log-rank p = 0.10) and invasive lobular cancer (HR 12.95, 95%CI 0.79–213.6, Log-rank p = 0.07) on positive margins. Conclusions: In the era of multimodal treatment of breast cancer and accurate strategies to reduce the probability of residual disease in the post-lumpectomy cavity, re-excision of positive margins might be omitted in selected patients with low-risk breast cancers.

Original languageEnglish
Pages (from-to)141-146
Number of pages6
JournalSurgical Oncology
Volume30
DOIs
Publication statusPublished - Sep 1 2019

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Segmental Mastectomy
Breast Neoplasms
Recurrence
Neoplasm Metastasis
Survival
Combined Modality Therapy
Propensity Score
Survival Analysis
Multivariate Analysis
Margins of Excision
Neoplasms

Keywords

  • Breast cancer
  • Breast-conserving surgery
  • Margins
  • Re-excision

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Involved margins after lumpectomy for breast cancer : Always to be re-excised? / Sorrentino, Luca; Agozzino, Manuela; Albasini, Sara; Bossi, Daniela; Mazzucchelli, Serena; Vanna, R.; Papadopoulou, Ourania; Villani, L.; Corsi, F.

In: Surgical Oncology, Vol. 30, 01.09.2019, p. 141-146.

Research output: Contribution to journalArticle

Sorrentino, Luca ; Agozzino, Manuela ; Albasini, Sara ; Bossi, Daniela ; Mazzucchelli, Serena ; Vanna, R. ; Papadopoulou, Ourania ; Villani, L. ; Corsi, F. / Involved margins after lumpectomy for breast cancer : Always to be re-excised?. In: Surgical Oncology. 2019 ; Vol. 30. pp. 141-146.
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abstract = "Background: The oncologic benefit of upfront re-excision of involved margins after breast-conserving surgery in the context of current multimodal clinical management of breast cancer is unclear. The aim of the present study was to assess the 5-years locoregional recurrence (LRR)-free and distant metastases (DM)-free survival probabilities in patients not undergoing re-excision of positive margins after lumpectomy for breast cancer. Methods: A cohort of 104 patients with positive margins not undergoing re-excision was matched by propensity score with a cohort of 2006 control patients with clear margins after breast-conserving surgery, treated between 2008 and 2018. A multivariate survival analysis was performed accounting for all variables related to LRR and DM, including adjuvant treatments. Results: After adjusting for potential confounders, avoiding to re-excise a positive margin after lumpectomy had no effect on 5-years LRR-free survival probability (HR 0.98, 95{\%}CI 0.36–2.67, p = 0.96) or 5-years DM-free survival probability (HR 0.37, 95{\%}CI 0.08–1.61, p = 0.18). No correlation was found between occurrence of LRR and number of involved margins (HR 1.28, 95{\%}CI 0.10–12.4, Log-rank p = 0.83), or extension of infiltrating disease (HR 1.21, 95{\%}CI 0.20–7.40, Log-rank p = 0.83), but a trend toward higher LRR probability was found for invasive ductal (HR 6.92, 95{\%}CI 0.7–68.8, Log-rank p = 0.10) and invasive lobular cancer (HR 12.95, 95{\%}CI 0.79–213.6, Log-rank p = 0.07) on positive margins. Conclusions: In the era of multimodal treatment of breast cancer and accurate strategies to reduce the probability of residual disease in the post-lumpectomy cavity, re-excision of positive margins might be omitted in selected patients with low-risk breast cancers.",
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T2 - Always to be re-excised?

AU - Sorrentino, Luca

AU - Agozzino, Manuela

AU - Albasini, Sara

AU - Bossi, Daniela

AU - Mazzucchelli, Serena

AU - Vanna, R.

AU - Papadopoulou, Ourania

AU - Villani, L.

AU - Corsi, F.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background: The oncologic benefit of upfront re-excision of involved margins after breast-conserving surgery in the context of current multimodal clinical management of breast cancer is unclear. The aim of the present study was to assess the 5-years locoregional recurrence (LRR)-free and distant metastases (DM)-free survival probabilities in patients not undergoing re-excision of positive margins after lumpectomy for breast cancer. Methods: A cohort of 104 patients with positive margins not undergoing re-excision was matched by propensity score with a cohort of 2006 control patients with clear margins after breast-conserving surgery, treated between 2008 and 2018. A multivariate survival analysis was performed accounting for all variables related to LRR and DM, including adjuvant treatments. Results: After adjusting for potential confounders, avoiding to re-excise a positive margin after lumpectomy had no effect on 5-years LRR-free survival probability (HR 0.98, 95%CI 0.36–2.67, p = 0.96) or 5-years DM-free survival probability (HR 0.37, 95%CI 0.08–1.61, p = 0.18). No correlation was found between occurrence of LRR and number of involved margins (HR 1.28, 95%CI 0.10–12.4, Log-rank p = 0.83), or extension of infiltrating disease (HR 1.21, 95%CI 0.20–7.40, Log-rank p = 0.83), but a trend toward higher LRR probability was found for invasive ductal (HR 6.92, 95%CI 0.7–68.8, Log-rank p = 0.10) and invasive lobular cancer (HR 12.95, 95%CI 0.79–213.6, Log-rank p = 0.07) on positive margins. Conclusions: In the era of multimodal treatment of breast cancer and accurate strategies to reduce the probability of residual disease in the post-lumpectomy cavity, re-excision of positive margins might be omitted in selected patients with low-risk breast cancers.

AB - Background: The oncologic benefit of upfront re-excision of involved margins after breast-conserving surgery in the context of current multimodal clinical management of breast cancer is unclear. The aim of the present study was to assess the 5-years locoregional recurrence (LRR)-free and distant metastases (DM)-free survival probabilities in patients not undergoing re-excision of positive margins after lumpectomy for breast cancer. Methods: A cohort of 104 patients with positive margins not undergoing re-excision was matched by propensity score with a cohort of 2006 control patients with clear margins after breast-conserving surgery, treated between 2008 and 2018. A multivariate survival analysis was performed accounting for all variables related to LRR and DM, including adjuvant treatments. Results: After adjusting for potential confounders, avoiding to re-excise a positive margin after lumpectomy had no effect on 5-years LRR-free survival probability (HR 0.98, 95%CI 0.36–2.67, p = 0.96) or 5-years DM-free survival probability (HR 0.37, 95%CI 0.08–1.61, p = 0.18). No correlation was found between occurrence of LRR and number of involved margins (HR 1.28, 95%CI 0.10–12.4, Log-rank p = 0.83), or extension of infiltrating disease (HR 1.21, 95%CI 0.20–7.40, Log-rank p = 0.83), but a trend toward higher LRR probability was found for invasive ductal (HR 6.92, 95%CI 0.7–68.8, Log-rank p = 0.10) and invasive lobular cancer (HR 12.95, 95%CI 0.79–213.6, Log-rank p = 0.07) on positive margins. Conclusions: In the era of multimodal treatment of breast cancer and accurate strategies to reduce the probability of residual disease in the post-lumpectomy cavity, re-excision of positive margins might be omitted in selected patients with low-risk breast cancers.

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