Main Article Content
Abstract
ABSTRACT
Introduction. The inadequate status of the resection margins after breast cancer surgery is an important predictor of local tumor recurrence. The objective of our study was to determine the factors associated with positive or invaded resection margins. Methodology. Our retrospective study included a cohort of 652 patients with early invasive breast cancer who underwent breast cancer conserving surgery at the Val d'Aurelle Regional Cancer Center. We defined positive margins as those with a distance of less than or equal to 2 mm from the tumour. Results. In our study, The median distance from the tumour to the surgical resection site was 5mm [0.0 - 35.0 mm]. Resection margins were positive in 208 patients (31.9%). The rate of positive resection margins was significantly higher in non-menopausal patients ( P =0,0050), , in those with tumours less than 2 cm in size (P = 0,0004), with ductal carcinoma in situ (DCIS) component and without lymph node involvement (P =0,0082) . Re-excision surgery was performed in 229 patients (35.1%). Conclusion. Consideration of each of these factors associated with positive resection margins should help the surgeons to perform a wider excision, in other to obtain clear resection margin during the initial breast cancer surgery.
RÉSUMÉ
Introduction. Le statut inadéquat des berges d’exérèse après chirurgie conservatrice du cancer du sein, représente le facteur prédictif prépondérant de récidives locales. L’objectif de notre étude était de déterminer les facteurs associés à des berges chirurgicales positives ou envahies. Méthodologie. Notre étude rétrospective a porté sur une cohorte de 652 patientes avec cancer invasif du sein au stade précoce, opérées au Centre régional de lutte contre le cancer Val d’Aurelle. Nous avons défini comme berges positives celles dont la distance les séparant de la tumeur était inférieure ou égale à 2 mm. Les données ont été analysées à l’aide du logiciel STATA® 10.0. Résultats. L’âge médian des patientes était de 54 ans [26-85 ans]. 53,7% (350) était ménopausées. La taille tumorale moyenne était de 1,99 cm (+/- 0,95). 66,3% (432) des tumeurs était < 2cm (T1). La distance médiane de la tumeur, à la berge d’exérèse chirurgicale était de 5mm [0,0 – 35,0mm]. 31,9% (208) des berges étaient positives, et 68,1% (444) étaient saines. La proportion de berges positives, était significativement plus élevée chez les patientes non ménopausées, chez celles avec tumeurs de moins de 2 cm, avec composante intracanalaire et sans envahissement ganglionnaire. Conclusion. la considération de chacun des facteurs associés à des berges positives, faciliterait le choix de l’étendue de la résection chirurgicale, limitant ainsi les risques de reprises chirurgicale.
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References
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- ’Institut National du Cancer, agence sanitaire, et scientifique chargée de coordonner la politique, de lutte contre le cancer en France., editors. Recommandations professionnelles : cancer du sein in situ,INCa, Boulogne-Billancourt. 2009.
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- Groot G, Rees H, Pahwa P, Kanagaratnam S, Kinloch M. Predicting local recurrence following breast-conserving therapy for early stage breast cancer: The significance of a narrow (≤2 mm) surgical resection margin: Resection Margin and Local Recurrence. J Surg Oncol [Internet]. 2011 Mar 1 [cited 2022 Mar 31];103(3):212–6. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jso.21826
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- Houssami N, Macaskill P, Marinovich ML, Dixon JM, Irwig L, Brennan ME, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer. 2010 Dec;46(18):3219–32.
- Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, et al. Cancer therapy and survivorship statistics, 2012. CA: A Cancer Journal for Clinicians [Internet]. 2012 Jul [cited 2022 Mar 31];62(4):220–41. Available from: http://doi.wiley.com/10.3322/caac.21149
- Kurniawan ED, Wong MH, Windle I, Rose A, Mou A, Buchanan M, et al. Predictors of Surgical Margin Status in Breast-Conserving Surgery Within a Breast Screening Program. Ann Surg Oncol [Internet]. 2008 Sep 1 [cited 2022 Mar 31];15(9):2542–9. Available from: https://doi.org/10.1245/s10434-008-0054-4
- Kouzminova NB, Aggarwal S, Aggarwal A, Allo MD, Lin AY. Impact of initial surgical margins and residual cancer upon re-excision on outcome of patients with localized breast cancer. The American Journal of Surgery [Internet]. 2009 Dec [cited 2022 Mar 31];198(6):771–80. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002961009005455
- Childs SK, Chen Y-H, Duggan MM, Golshan M, Pochebit S, Wong JS, et al. Surgical Margins and the Risk of Local-Regional Recurrence After Mastectomy Without Radiation Therapy. International Journal of Radiation Oncology*Biology*Physics [Internet]. 2012 Dec [cited 2022 Mar 31];84(5):1133–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0360301612003173
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- Reedijk M, Hodgson N, Gohla G, Boylan C, Goldsmith CH, Foster G, et al. A prospective study of tumor and technical factors associated with positive margins in breast-conservation therapy for nonpalpable malignancy. The American Journal of Surgery [Internet]. 2012 Sep [cited 2022 Mar 31];204(3):263–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002961012003042
- Lovrics PJ, Cornacchi SD, Farrokhyar F, Garnett A, Chen V, Franic S, et al. The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer. The American Journal of Surgery [Internet]. 2009 Jun [cited 2022 Mar 31];197(6):740–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002961008005308
- Leong C, Boyages J, Jayasinghe UW, Bilous M, Ung O, Chua B, et al. Effect of margins on ipsilateral breast tumor recurrence after breast conservation therapy for lymph node-negative breast carcinoma. Cancer [Internet]. 2004 May 1 [cited 2022 Mar 31];100(9):1823–32. Available from: https://onlinelibrary.wiley.com/doi/10.1002/cncr.20153
- Kontos M, Roy P, Rizos D, Hamed H. An evidence based strategy for follow up after breast conserving therapy for breast cancer: Follow Up for Breast Cancer. J Surg Oncol [Internet]. 2011 Sep 1 [cited 2022 Mar 31];104(3):223–7. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jso.21747
References
Le cancer du sein - Les cancers les plus fréquents [Internet]. [cited 2022 Mar 29]. Available from: https://www.e-cancer.fr/Professionnels-de-sante/Les-chiffres-du-cancer-en-France/Epidemiologie-des-cancers/Les-cancers-les-plus-frequents/Cancer-du-sein
’Institut National du Cancer, agence sanitaire, et scientifique chargée de coordonner la politique, de lutte contre le cancer en France., editors. Recommandations professionnelles : cancer du sein in situ,INCa, Boulogne-Billancourt. 2009.
Local Recurrence after Breast-Conserving Surgery: - ProQuest [Internet]. [cited 2022 Mar 29]. Available from: https://www.proquest.com/docview/929133080
Wimmer K, Bolliger M, Bago-Horvath Z, Steger G, Kauer-Dorner D, Helfgott R, et al. Impact of Surgical Margins in Breast Cancer After Preoperative Systemic Chemotherapy on Local Recurrence and Survival. Ann Surg Oncol [Internet]. 2020 [cited 2022 Mar 29];27(5):1700–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138765/
Groot G, Rees H, Pahwa P, Kanagaratnam S, Kinloch M. Predicting local recurrence following breast-conserving therapy for early stage breast cancer: The significance of a narrow (≤2 mm) surgical resection margin: Resection Margin and Local Recurrence. J Surg Oncol [Internet]. 2011 Mar 1 [cited 2022 Mar 31];103(3):212–6. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jso.21826
Pilewskie M, Morrow M. Margins in breast cancer: How much is enough? Cancer. 2018 01;124(7):1335–41.
Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ. Ann Surg Oncol [Internet]. 2016 Nov [cited 2020 May 23];23(12):3801–10. Available from: http://link.springer.com/10.1245/s10434-016-5449-z
Houssami N, Macaskill P, Marinovich ML, Dixon JM, Irwig L, Brennan ME, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer. 2010 Dec;46(18):3219–32.
Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, et al. Cancer therapy and survivorship statistics, 2012. CA: A Cancer Journal for Clinicians [Internet]. 2012 Jul [cited 2022 Mar 31];62(4):220–41. Available from: http://doi.wiley.com/10.3322/caac.21149
Kurniawan ED, Wong MH, Windle I, Rose A, Mou A, Buchanan M, et al. Predictors of Surgical Margin Status in Breast-Conserving Surgery Within a Breast Screening Program. Ann Surg Oncol [Internet]. 2008 Sep 1 [cited 2022 Mar 31];15(9):2542–9. Available from: https://doi.org/10.1245/s10434-008-0054-4
Kouzminova NB, Aggarwal S, Aggarwal A, Allo MD, Lin AY. Impact of initial surgical margins and residual cancer upon re-excision on outcome of patients with localized breast cancer. The American Journal of Surgery [Internet]. 2009 Dec [cited 2022 Mar 31];198(6):771–80. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002961009005455
Childs SK, Chen Y-H, Duggan MM, Golshan M, Pochebit S, Wong JS, et al. Surgical Margins and the Risk of Local-Regional Recurrence After Mastectomy Without Radiation Therapy. International Journal of Radiation Oncology*Biology*Physics [Internet]. 2012 Dec [cited 2022 Mar 31];84(5):1133–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0360301612003173
Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, Edge SB, et al. Invasive Breast Cancer. J Natl Compr Canc Netw [Internet]. 2011 Feb [cited 2022 Mar 31];9(2):136–222. Available from: https://jnccn.org/view/journals/jnccn/9/2/article-p136.xml
Shin H-C, Han W, Moon H-G, Cho N, Moon WK, Park I-A, et al. Nomogram for predicting positive resection margins after breast-conserving surgery. Breast Cancer Res Treat [Internet]. 2012 Aug [cited 2022 Mar 31];134(3):1115–23. Available from: http://link.springer.com/10.1007/s10549-012-2124-3
Reedijk M, Hodgson N, Gohla G, Boylan C, Goldsmith CH, Foster G, et al. A prospective study of tumor and technical factors associated with positive margins in breast-conservation therapy for nonpalpable malignancy. The American Journal of Surgery [Internet]. 2012 Sep [cited 2022 Mar 31];204(3):263–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002961012003042
Lovrics PJ, Cornacchi SD, Farrokhyar F, Garnett A, Chen V, Franic S, et al. The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer. The American Journal of Surgery [Internet]. 2009 Jun [cited 2022 Mar 31];197(6):740–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002961008005308
Leong C, Boyages J, Jayasinghe UW, Bilous M, Ung O, Chua B, et al. Effect of margins on ipsilateral breast tumor recurrence after breast conservation therapy for lymph node-negative breast carcinoma. Cancer [Internet]. 2004 May 1 [cited 2022 Mar 31];100(9):1823–32. Available from: https://onlinelibrary.wiley.com/doi/10.1002/cncr.20153
Kontos M, Roy P, Rizos D, Hamed H. An evidence based strategy for follow up after breast conserving therapy for breast cancer: Follow Up for Breast Cancer. J Surg Oncol [Internet]. 2011 Sep 1 [cited 2022 Mar 31];104(3):223–7. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jso.21747