The Association of Surgical Margins and Local Recurrence in Women with Early-Stage Invasive Breast Cancer Treated with Breast-Conserving Therapy: A Meta-Analysis

Annals of Surgical Oncology - Tập 21 Số 3 - Trang 717-730 - 2014
Nehmat Houssami1, Petra Macaskill1, M. Luke Marinovich1, Monica Morrow2
1Screening and Test Evaluation Program (STEP), School of Public Health, A27, Sydney Medical School, University of Sydney, Sydney, Australia
2Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA

Tóm tắt

Từ khóa


Tài liệu tham khảo

Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.

Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.

Van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;92:1143–50.

Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer. 2003;98:697-702.

Blichert-Toft M, Rose C, Andersen JA, et al. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr. 1992;(11):19–25.

Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–106.

Newman LA, Kuerer HM. Advances in breast conservation therapy. J Clin Oncol. 2005;23:1685–97.

Morrow M, Strom EA, Bassett LW et al. Standard for breast conservation therapy in the management of invasive breast carcinoma. CA Cancer J Clin. 2002;52:277–300.

Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184:383–93.

Houssami N, Macaskill P, Marinovich ML, 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;46:3219–32.

Carlson RW, Allred DC, Anderson BO, et al. Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2009;7:122–92.

Schwartz GF, Veronesi U, Clough KB, et al. Consensus conference on breast conservation. J Am Coll Surg. 2006;203:198–207.

Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184:383–93.

Morrow M. Margins in breast-conserving therapy: have we lost sight of the big picture? Expert Rev Anticancer Ther. 2008;8:1193–6.

Taghian A, Mohiuddin M, Jagsi R, Goldberg S, Ceilley E, Powell S. Current perceptions regarding surgical margin status after breast-conserving therapy: results of a survey. Ann Surg. 2005;241:629–39.

Luini A, Rososchansky J, Gatti G, et al. The surgical margin status after breast-conserving surgery: discussion of an open issue. Breast Cancer Res Treat. 2009;113:397–402.

MacDonald S, Taghian AG. Prognostic factors for local control after breast conservation: does margin status still matter? J Clin Oncol. 2009;27:4929–30.

McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in reexcision following breast conservation surgery. J Am Med Assoc. 2012;307:467–75.

Sakamoto G, Inaji H, Akiyama F, et al. General rules for clinical and pathological recording of breast cancer 2005. Breast Cancer. 2005;12 Suppl:27.

Morrow M, Jagsi R, Alderman AK, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. J Am Med Assoc. 2009;302:1551–6.

Altman DG. Systematic reviews of evaluations of prognostic variables. In: Egger M, Smith GD, Altman DG, eds. Systematic reviews in health care: meta-analysis in context, 2nd edn. London: BMJ Publishing Group; 2001:228–47.

Randolph A, Bucher H, Richardson WS, et al. Prognosis. In: Guyatt G, Rennie D, eds. Users’ guide to the medical literature. A manual for evidence-based clinical practice. Chicago: AMA Press; 2002; 141–54.

Livi L, Meattini I, Franceschini D, et al. Radiotherapy boost dose-escalation for invasive breast cancer after breast-conserving surgery: 2093 patients treated with a prospective margin-directed policy. Radiother Oncol. 2013;108:273–8.

Demirci S, Broadwater G, Marks LB, Clough R, Prosnitz LR. Breast conservation therapy: the influence of molecular subtype and margins. Int J Radiat Oncol Biol Phys. 2012;83:814–20.

Lupe K, Truong PT, Alexander C, Lesperance M, Speers C, Tyldesley S. Subsets of women with close or positive margins after breast-conserving surgery with high local recurrence risk despite breast plus boost radiotherapy. Int J Radiat Oncol Biol Phys. 2011;81:e561–8.

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. J Surg Oncol. 2011;103:212–6.

Liau SS, Cariati M, Noble D, Wilson C, Wishart GC. Audit of local recurrence following breast conservation surgery with 5-mm target margin and hypofractionated 40-Gray breast radiotherapy for invasive breast cancer. Ann Royal Coll Surg Engl. 2010;92:562–8.

Whipp E, Beresford M, Sawyer E, Halliwell M. True local recurrence rate in the conserved breast after magnetic resonance imaging-targeted radiotherapy. Int J Radiat Oncol Biol Phys. 2010;76:984–90.

Kreike B, Hart AAM, van de Velde T, et al. Continuing risk of ipsilateral breast relapse after breast-conserving therapy at long-term follow-up. Int J Radiat Oncol Biol Phys. 2008;71:1014–21.

Ewertz M, Moe Kempel M, During M, et al. Breast conserving treatment in Denmark, 1989–1998. A nationwide population-based study of the Danish Breast Cancer Co-operative Group. Acta Oncol. 2008;47:682–90.

Varghese P, Gattuso JM, Mostafa AIH, et al. The role of radiotherapy in treating small early invasive breast cancer. Eur J Surg Oncol. 2008;34:369–76.

Livi L, Paiar F, Saieva C, et al. Survival and breast relapse in 3834 patients with T1-T2 breast cancer after conserving surgery and adjuvant treatment. Radiother Oncol. 2007;82:287–93.

Kunos C, Latson L, Overmoyer B, et al. Breast conservation surgery achieving > or =2 mm tumor-free margins results in decreased local-regional recurrence rates. Breast J. 2006;12:28–36.

Kasumi F, Takahashi K, Nishimura S, et al. CIH-Tokyo experience with breast-conserving surgery without radiotherapy: 6.5 year follow-up results of 1462 patients. Breast J. 2006;12:Suppl-90.

Karasawa K, Mitsumori M, Yamauchi C, et al. Treatment outcome of breast-conserving therapy in patients with positive or close resection margins: Japanese multi-institute survey for radiation dose effect. Breast Cancer. 2005;12:91–8.

Bellon JR, Come SE, Gelman RS, et al. Sequencing of chemotherapy and radiation therapy in early-stage breast cancer: updated results of a prospective randomized trial. J Clin Oncol. 2005;23:1934–40.

Santiago RJ, Wu L, Harris E, et al. Fifteen-year results of breast-conserving surgery and definitive irradiation for stage I and II breast carcinoma: The University of Pennsylvania experience. Int J Radiat Oncol Biol Phys. 2004;58:233–40.

Leong C, Boyages J, Jayasinghe UW, et al. Effect of margins on ipsilateral breast tumor recurrence after breast conservation therapy for lymph node-negative breast carcinoma. Cancer. 2004;100:1823–32.

Neuschatz AC, DiPetrillo T, Safaii H, Price LL, Schmidt-Ullrich RK, Wazer DE. Long-term follow-up of a prospective policy of margin-directed radiation dose escalation in breast-conserving therapy. Cancer. 2003;97:30–9.

Goldstein NS, Kestin L, Vicini F. Factors associated with ipsilateral breast failure and distant metastases in patients with invasive breast carcinoma treated with breast-conserving therapy: a clinicopathologic study of 607 neoplasms from 583 patients. Am J Clin Pathol. 2003;120:500–27.

Perez CA. Conservation therapy in T1-T2 breast cancer: past, current issues, and future challenges and opportunities. Cancer J. 2003;9:442–53.

Smitt MC, Nowels K, Carlson RW, Jeffrey SS. Predictors of reexcision findings and recurrence after breast conservation. Int J Radiat Oncol Biol Phys. 2003;57:979–85.

Karasawa K, Obara T, Shimizu T, et al. Outcome of breast-conserving therapy in the Tokyo Women’s Medical University Breast Cancer Society experience. Breast Cancer. 2003;10:241–8.

McBain CA, Young EA, Swindell R, Magee B, Stewart AL. Local recurrence of breast cancer following surgery and radiotherapy: incidence and outcome. Clin Oncol (R Coll Radiol). 2003;15:25–31.

Mirza NQ, Vlastos G, Meric F, et al. Predictors of locoregional recurrence among patients with early-stage breast cancer treated with breast-conserving therapy. Ann Surg Oncol. 2002;9:256–65.

Horiguchi J, Koibuchi Y, Takei H, et al. Breast-conserving surgery following radiation therapy of 50 Gy in stages I and II carcinoma of the breast: the experience at one institute in Japan. Oncol Rep. 2002;9:1053–7.

Voogd AC, Nielsen M, Peterse JL, et al. Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials. J Clin Oncol. 2001;19:1688–97.

Kokubo M, Mitsumori M, Ishikura S, et al. Results of breast-conserving therapy for early stage breast cancer: Kyoto university experiences. Am J Clin Oncol Cancer Clin Trials. 2000;23:499–505.

Park CC, Mitsumori M, Nixon A, et al. Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: Influence of margin status and systemic therapy on local recurrence. J Clin Oncol 2000;18:1668–1675.

Touboul E, Buffat L, Belkacemi Y, et al. Local recurrences and distant metastases after breast-conserving surgery and radiation therapy for early breast cancer. Int J Radiat Oncol Biol Phys 1999;43:25–38.

Freedman G, Fowble B, Hanlon A, et al. Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy. Int J Radiat Oncol Biol Phys 1999;44:1005–1015.

Obedian E, Haffty B. Negative margin status improves local control in conservatively managed breast cancer patients. Cancer J Sci Am 1999;6:28–33.

Pierce LJ, Strawderman MH, Douglas KR, Lichter AS. Conservative surgery and radiotherapy for early-stage breast cancer using a lung density correction: the University of Michigan experience. Int J Radiat Oncol Biol Phys. 1997;39:921–928.

Burke MF, Allison R, Tripcony L. Conservative therapy of breast cancer in Queensland. Int J Radiat Oncol Biol Phys. 1995;31:295–303.

Spivack B, Khanna MM, Tafra L, Juillard G, Giuliano AE. Margin status and local recurrence after breast-conserving surgery. Archives of Surg. 1994;129:952–956.

Freedman GM, Hanlon AL, Fowble BL, Anderson PR, Nicolaou N. Recursive partitioning identifies patients at high and low risk for ipsilateral tumor recurrence after breast-conserving surgery and radiation [erratum J Clin Oncol 2002;20(24):4727]. J Clin Oncol. 2002;20:4015–21.

Schnitt SJ, Abner A, Gelman R, et al. The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer. 1994;74:1746–51.

Gage I, Schnitt SJ, Nixon AJ, et al. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer. 1996;78:1921–8.

Cabioglu N, Hunt KK, Buchholz TA, et al. Improving local control with breast-conserving therapy: a 27-year single-institution experience. Cancer. 2005;104:20–9.

Horiguchi J, Iino Y, Takei H, et al. Surgical margin and breast recurrence after breast-conserving therapy. Oncol Rep. 1999;6:135–8.

Wazer DE, Schmidt-Ullrich RK, Ruthazer R, et al. Factors determining outcome for breast-conserving irradiation with margin-directed dose escalation to the tumor bed. Int J Radiat Oncol Biol Phys. 1998;40:851–8.

Smitt MC, Nowels KW, Zdeblick MJ, et al. The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer. 1995;76:259–67.

Solin LJ, Fowble BL, Schultz DJ, Goodman RL. The significance of the pathology margins of the tumor excision on the outcome of patients treated with definitive irradiation for early-stage breast cancer [see comment]. Int J Radiat Oncol Biol Phys. 1991;21:279–87.

Peterson ME, Schultz DJ, Reynolds C, Solin LJ. Outcomes in breast cancer patients relative to margin status after treatment with breast-conserving surgery and radiation therapy: the University of Pennsylvania experience. Int J Radiat Oncol Biol Phys. 1999;43:1029–35.

Recht A, Come SE, Henderson IC, et al. The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer. N Engl J Med. 1996;334:1356–61.

Borger J, Kemperman H, Hart A, Peterse H, van Dongen J, Bartelink H. Risk factors in breast-conservation therapy. J Clin Oncol. 1994;12:653–60.

Kini VR, White JR, Horwitz EM, Dmuchowski CF, Martinez AA, Vicini FA. Long term results with breast-conserving therapy for patients with early-stage breast carcinoma in a community hospital setting. Cancer. 1998;82:127–33.

DiBiase SJ, Komarnicky LT, Heron DE, Schwartz GF, Mansfield CM. Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy. Int J Radiat Oncol Biol Phys. 2002;53:680–6.

Tartter PI, Kaplan J, Bleiweis I, et al. Lumpectomy margins, reexcision, and local recurrence of breast cancer. Am J Surg. 2000;179:81–5.

Renton SC, Gazet JC, Ford HT, Corbishley C, Sutcliffe R. The importance of the resection margin in conservative surgery for breast cancer. Eur J Surg Oncol. 1996;22:17–22.

Truong PT, Jones SO, Kader HA, et al. Patients with t1 to t2 breast cancer with one to three positive nodes have higher local and regional recurrence risks compared with node-negative patients after breast-conserving surgery and whole-breast radiotherapy. Int J Radiat Oncol Biol Phys. 2009;73:357–64.

Poortmans PM, Collette L, Horiot JC, et al. Impact of the boost dose of 10 Gy versus 26 Gy in patients with early stage breast cancer after a microscopically incomplete lumpectomy: 10-year results of the randomised EORTC boost trial. Radiother Oncol. 2009;90:80–5.

Pittinger TP, Maronian NC, Poulter CA, et al. Importance of margin status in outcome of breast-conserving surgery for carcinoma. Surgery. 1994;116:605–9.

Yau TK, Soong IS, Chan K et al. Clinical outcome of breast conservation therapy for breast cancer in Hong Kong: prognostic impact of ipsilateral breast tumor recurrence and 2005 St. Gallen risk categories. Int J Radiat Oncol Biol Phys. 2007;68:667–72.

Bollet MA, Sigal-Zafrani B, Mazeau V, et al. Age remains the first prognostic factor for loco-regional breast cancer recurrence in young (<40 years) women treated with breast conserving surgery first. Radiother Oncol. 2007;82:272–80.

Hardy K, Fradette K, Gheorghe R, Lucman L, Latosinsky S. The impact of margin status on local recurrence following breast conserving therapy for invasive carcinoma in Manitoba. J Surg Oncol 2008;98:399–402.

Rauschecker HF, Sauerbrei W, Gatzemeier W, et al. Eight-year results of a prospective non-randomised study on therapy of small breast cancer. The German Breast Cancer Study Group (GBSG). Eur J Cancer. 1998;34:315–23.

Jones HA, Antonini N, Hart AA, et al. Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol. 2009;27:4939–47.

Yoshida T, Takei H, Kurosumi M, et al. Ipsilateral breast tumor relapse after breast conserving surgery in women with breast cancer. Breast 2009;18:238–43.

Vujovic O, Cherian A, Yu E, Dar AR, Stitt L, Perera F. The effect of timing of radiotherapy after breast-conserving surgery in patients with positive or close resection margins, young age, and node-negative disease, with long term follow-up. Int J Radiat Oncol Biol Phys. 2006;66:687–90.

Rodriguez PA, Samper Ots PM, Lopez Carrizosa MC, et al. Early-stage breast cancer conservative treatment: high-dose-rate brachytherapy boost in a single fraction of 700 cGy to the tumour bed. Clin Transl Oncol. 2012;14:362–8.

Jobsen JJ, van der Palen J, Ong F, Meerwaldt JH. Differences in outcome for positive margins in a large cohort of breast cancer patients treated with breast-conserving therapy. Acta Oncol. 2007;46:172–80.

Galimberti V, Maisonneuve P, Rotmensz N, et al. Influence of margin status on outcomes in lobular carcinoma: experience of the European Institute of Oncology. Ann Surg. 2011;253:580–4.

McCahill LE, Single R, Ratliff J, Sheehey-Jones J, Gray A, James T. Local recurrence after partial mastectomy: relation to initial surgical margins. Am J Surg. 2011;201:374–8.

Schroeder TM, Liem B, Sampath S, Thompson WR, Longhurst J, Royce M. Early breast cancer with positive margins: excellent local control with an upfront brachytherapy boost. Breast Cancer Res Treat. 2012;134:719–25.

Liu J, Hao XS, Yu Y, et al. Long-term results of breast conservation in Chinese women with breast cancer. Breast J. 2009;15:296–8.

Shimauchi A, Nemoto K, Ogawa Y, et al. Long-term outcome of breast-conserving therapy for breast cancer. Radiat Med. 2005;23:485–90.

Ohsumi S, Sakamoto G, Takashima S, et al. Long-term results of breast-conserving treatment for early-stage breast cancer in Japanese women from multicenter investigation. Jpn J Clin Oncol. 2003;33:61–7.

Vordermark D, Lackenbauer A, Wulf J, Guckenberger M, Flentje M. Local control in 118 consecutive high-risk breast cancer patients treated with breast-conserving therapy. Oncol Rep. 2007;18:1335–9.

Azu M, Abrahamse P, Katz SJ, Jagsi R, Morrow M. What is an adequate margin for breast-conserving surgery? Surgeon attitudes and correlates. Ann Surg Oncol. 2010;17:558–63.

Marudanayagam R, Singhal R, Tanchel B, O’Connor B, Balasubramanian B, Paterson I. Effect of cavity shaving on reoperation rate following breast-conserving surgery. Breast J. 2008;14:570–3.

Waljee JF, Hu ES, Newman LA, Alderman AK. Predictors of re-excision among women undergoing breast-conserving surgery for cancer. Ann Surg Oncol. 2008;15:1297–303.

Huston TL, Pigalarga R, Osborne MP, Tousimis E. The influence of additional surgical margins on the total specimen volume excised and the reoperative rate after breast-conserving surgery. Am J Surg. 2006;192:509–12.

Morrow M, Harris JR, Schnitt SJ. Surgical margins in lumpectomy for breast cancer: bigger is not better. N Engl J Med. 2012;367:79–82.

Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005;353:1673–84.

Kiess AP, McArthur HL, Mahoney K, et al. Adjuvant trastuzumab reduces locoregional recurrence in women who receive breast-conservation therapy for lymph node-negative, human epidermal growth factor receptor 2-positive breast cancer. Cancer. 2012;118:1982–8.

Voduc KD, Cheang MCU, Tyldesley S, Gelmon K, Nielsen TO, Kennecke H. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol. 2010;28:1684–91.

Arvold ND, Taghian AG, Niemierko A, et al. Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol. 2011;29:3885–91.

Lowery AJ, Kell MR, Glynn RW, Kerin MJ, Sweeney KJ. Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res Treat. 2012;133:831–41.

Lagios MD. Multicentricity of breast carcinoma demonstrated by routine correlated serial subgross and radiographic examination. Cancer. 1977;40:1726–34.

Holland R, Veling SH, Mravunac M, Hendriks JH. Histologic multifocality of Tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer. 1985;56:979–90.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. 2009 (online source).