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Margin status and the risk of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy

  • Epidemiology
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Abstract

We sought to assess whether a close surgical margin (>0 and <2 mm) after breast-conserving therapy (BCT) confers an increased risk of local recurrence (LR) compared with a widely negative margin (≥2 mm). We studied 906 women with early-stage invasive breast cancer treated with BCT between January 1998 and October 2006; 91 % received adjuvant systemic therapy. Margins were coded as: (1) widely negative (n = 729), (2) close (n = 85), or (3) close (n = 84)/positive (n = 8) but having no additional tissue to remove according to the surgeon. Cumulative incidence of LR and distant failure (DF) were calculated using the Kaplan–Meier method. Gray’s competing-risk regression assessed the effect of margin status on LR and Cox proportional hazards regression assessed the effect on DF, controlling for biologic subtype, age, and number of positive lymph nodes (LNs). Three hundred seventy-seven patients (41.6 %) underwent surgical re-excision, of which 63.5 % had no residual disease. With a median follow-up of 87.5 months, the 5-year cumulative incidence of LR was 2.5 %. The 5-year cumulative incidence of LR by margin status was 2.3 % (95 % CI 1.4–3.8 %) for widely negative, 0 % for close, and 6.4 % (95 % CI 2.7–14.6 %) for no additional tissue, p = 0.3. On multivariate analysis, margin status was not associated with LR; however, triple-negative subtype (AHR 3.7; 95 % CI 1.6–8.8; p = 0.003) and increasing number of positive LNs (AHR 1.6; 95 % CI 1.1–2.3; p = 0.025) were associated. In an era of routine adjuvant systemic therapy, close surgical margins and maximally resected close/positive margins were not associated with an increased risk of LR compared to widely negative margins. Additional studies are needed to confirm this finding.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Harvard Radiation Oncology Program, Boston, MA, USA

    Andrea L. Russo

  2. Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA, 02215, USA

    Nils D. Arvold, Nathan Wong, Julia S. Wong, Jennifer R. Bellon, Rinaa S. Punglia & Jay R. Harris

  3. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA

    Andrzej Niemierko

  4. Surgical Oncology Division, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA, USA

    Mehra Golshan & Susan L. Troyan

  5. Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA

    Jane E. Brock

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  1. Andrea L. Russo
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Correspondence to Jay R. Harris.

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Russo, A.L., Arvold, N.D., Niemierko, A. et al. Margin status and the risk of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy. Breast Cancer Res Treat 140, 353–361 (2013). https://doi.org/10.1007/s10549-013-2627-6

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