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Negative margin status improves local control in conservatively managed breast cancer patients.
1Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8040, USA.
The Cancer Journal From Scientific American
|March 4, 2000
Summary
Achieving negative margins after breast cancer surgery significantly improves breast relapse-free survival. Close margins are as effective as negative margins, while positive margins are linked to poorer outcomes, underscoring the need for re-excision.
Area of Science:
- Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- Conservative surgery and radiation therapy are standard treatments for invasive breast cancer.
- Pathologic margin status is a critical factor influencing treatment outcomes.
- Understanding the impact of margin status is essential for optimizing patient management.
Purpose of the Study:
- To evaluate the effect of final pathologic margin status on breast relapse-free survival (BRFS), distant metastasis-free survival (DMFS), and overall survival (OS).
- To assess outcomes in patients treated with conservative surgery and radiation therapy for invasive breast cancer.
Main Methods:
- Retrospective analysis of 984 patients treated between 1970 and 1990.
- Patients were categorized into four margin status groups: negative, close (within 2 mm), positive, and indeterminate.
- Outcomes including BRFS, DMFS, and OS were analyzed with a median follow-up of 13 years.
Main Results:
- Negative margin status was associated with improved BRFS (98%) compared to positive (83%) and indeterminate (82%) margins.
- Close margins showed similar BRFS (98%) to negative margins.
- While negative margins showed a trend towards better DMFS and OS, these were confounded by earlier disease stage; margin status did not independently influence OS in multivariate analysis.
Conclusions:
- Negative and close margin status significantly improve breast relapse-free survival in patients undergoing conservative breast cancer treatment.
- Indeterminate margins are associated with outcomes similar to positive margins.
- Re-excision to achieve clear surgical margins is recommended, even with planned radiation boost or adjuvant systemic therapy.
