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Multicenter Study
. 2020 May;27(5):1700-1707.
doi: 10.1245/s10434-019-08089-x. Epub 2019 Dec 23.

Impact of Surgical Margins in Breast Cancer After Preoperative Systemic Chemotherapy on Local Recurrence and Survival

K Wimmer  1   2 , M Bolliger  1   2 , Z Bago-Horvath  2   3 , G Steger  2   4 , D Kauer-Dorner  2   5 , R Helfgott  6 , C Gruber  7 , F Moinfar  7 , M Mittlböck  8 , F Fitzal  9   10
Affiliations
Multicenter Study

Impact of Surgical Margins in Breast Cancer After Preoperative Systemic Chemotherapy on Local Recurrence and Survival

K Wimmer et al. Ann Surg Oncol. 2020 May.

Abstract

Background: While "no tumour on ink" is an accepted margin width for R0 resection in primary surgery, it's unclear if it's oncologically safe after neoadjuvant chemotherapy (NAC). Only limited data demonstrate that surgery within new margins in cases of a pathological complete response (pCR) is safe. We therefore investigated the influence of different margins and pCR on local recurrence and survival rates after NAC.

Methods: We retrospectively analysed data of 406 women with invasive breast cancer, treated with NAC and breast-conserving therapy between 1994 and 2014 in two certified Austrian breast health centres. We compared R ≤ 1 mm, R > 1 mm and RX (pCR) for local recurrence-free survival (LRFS), disease-free survival (DFS) and overall survival (OS).

Results: After a median follow-up of 84.3 months, the 5-year LRFS (R ≤ 1 mm: 94.2%, R > 1 mm: 90.6%, RX: 95.0%; p = 0.940), the 5-year DFS (R ≤ 1 mm: 71.9%, R > 1 mm: 74.1%, RX: 87.2%; p = 0.245) and the 5-year OS (R ≤ 1 mm: 85.1%, R > 1 mm: 88.0%, RX: 96.4%; p = 0.236) did not differ significantly between narrow, wide, nor RX resections. Regarding DFS and OS, a negative nodal status reduced the hazard ratio significantly.

Conclusion: There is no significant difference in LRFS, DFS and OS comparing close, wide or unknown margins after pCR. We suggest that resection in new margins after NAC is safe according to "no tumour on ink". Resection of the clipped area in cases of pCR is emphasized.

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Conflict of interest statement

Dr. Wimmer reports travel grants from Roche and Pfizer, outside the submitted work. Dr. Bolliger reports personal fees from Pfizer for congress support, outside the submitted work. Dr. Bago-Horvath reports other from Roche, grants from Boehringer-Ingelheim and personal fees from Novartis, outside the submitted work. Dr. Kauer-Dorner reports personal fees from Roche, outside the submitted work. Dr. Fitzal reports support from Roche, from Pfizer, from Novartis, from Astra Zeneca and from Polytech for advisery boards, meetings, and lectures, outside the submitted work. Dr. Steger, Dr. Helfgott, Dr. Gruber, Dr. Moinfar and Dr. Mittlböck have nothing to disclose. Regarding this work, none of the authors reports any conflicts of interest.

Figures

Fig. 1
Fig. 1
Survival curves “R0” versus “RX”. Kaplan–Meier curves show LRFS, DFS and OS for patients with either “R0” (red solid) or “RX” (blue solid) resections
Fig. 2
Fig. 2
Survival Curves “R ≤ 1 mm”, “R > 1 mm” and “RX”. Kaplan–Meier curves show LRFS, DFS and OS for patients with “R ≤ 1 mm” (green solid, “R > 1 mm” (red solid) or “RX” (blue solid) resection
Fig. 3
Fig. 3
Multivariate analysis of risk factors. Multivariate analysis of risk factors shows that a negative nodal status after NAC significantly lowered the HR for events regarding OS and DFS. HER2 human epidermal growth factor receptor 2, Ki67 proliferation index, G grading, PR progesterone receptor, ER estrogen receptor, ypN N stage after neoadjuvant chemotherapy, R margin status, statistically significant results are in red
See this image and copyright information in PMC

References

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