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Margins in Breast-Conserving Surgery After Neoadjuvant Therapy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 25 August 2018

This article has been updated

Abstract

Background

Optimal margin width for breast-conserving therapy (BCT) after neoadjuvant chemotherapy (NAC) is unknown. We sought to determine the impact of margin width on local recurrence and survival after NAC and BCT.

Methods

Patients treated with NAC and BCT for stage I–III breast cancer from 2002 to 2014 were identified. Multivariate Cox regression was performed to determine the relationship between margin width and local recurrence free-survival (LRFS), disease-free survival (DFS), and overall survival (OS).

Results

A total of 382 patients were included. Median age was 51 years [range 22–79], median tumor size 3.0 cm [range 0.6–11.0], and receptor subtypes included 144 (37.7%) HR−/HER2−, 47 (12.3%) HR−/HER2+, 118 (30.9%) HR+/HER2−, and 70 (18.3%) HR+/HER2+. Breast pathologic complete response (pCR) was achieved in 105 (27.5%) patients. Final margin status was positive in 8 (2.1%) patients, ≤ 1 mm in 65 (17.0%), 1.1–2 mm in 30 (7.9%), and > 2 mm in 174 (45.5%). The 5-year LRFS was 96.3% (95% CI 94.0–98.6), DFS was 85.5% (95% CI 81.8–90.7), and OS was 90.8% (95% CI 87.4–94.2). There was no difference in LRFS, DFS, or OS for margins ≤ 2 versus > 2 mm, and no difference in DFS or OS for margins ≤ 1 versus > 1 mm. HR+ subtype (p = 0.04) and pCR (p = 0.03) were correlated with favorable DFS and node negativity (p < 0.001) with favorable DFS and OS.

Conclusions

In this cohort treated with NAC and BCT, there was no association between margin width and LRFS, DFS, or OS. Although further studies are needed, the excellent long-term outcomes demonstrated in patients with close (≤ 2 mm) margins following NAC suggest that a margin of “no-ink-on-tumor” may be acceptable in appropriately selected patients.

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Change history

  • 25 August 2018

    In the original article, there is an error in Jungeun Choi’s affiliation. It is corrected as reflected here.

  • 25 August 2018

    In the original article, there is an error in Jungeun Choi?s affiliation. It is corrected as reflected here.

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Disclosures

The authors have no disclosures to declare.

Author information

Author notes

  1. Alison Laws MD

    Present address: Department of Surgery, University of Calgary, Calgary, AB, Canada

Authors and Affiliations

  1. Department of Surgery, Yeungnam University College of Medicine, Gyeongsan, South Korea

    Jungeun Choi MD

  2. Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Alison Laws MD, Mehra Golshan MD & Tari King MD

  3. Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Alison Laws MD, Mehra Golshan MD & Tari King MD

  4. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    Jiani Hu MPH & William Barry PhD

Authors
  1. Jungeun Choi MD
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  2. Alison Laws MD
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  3. Jiani Hu MPH
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  4. William Barry PhD
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  5. Mehra Golshan MD
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  6. Tari King MD
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Corresponding author

Correspondence to Tari King MD.

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Choi, J., Laws, A., Hu, J. et al. Margins in Breast-Conserving Surgery After Neoadjuvant Therapy. Ann Surg Oncol 25, 3541–3547 (2018). https://doi.org/10.1245/s10434-018-6702-4

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  • DOI: https://doi.org/10.1245/s10434-018-6702-4

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