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Safe Negative Margin Width in Breast Conservative Therapy: Results from a Population with a High Percentage of Negative Prognostic Factors

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Abstract

Background

There remains a controversy in the literature regarding adequate width of negative surgical margins in breast conservative therapy (BCT). It is now advocated that no tumor on an inked margin is a safe negative margin. Majority of studies on the outcomes of BCT had patients with favorable prognostic factors. Pakistani population has a high expression of unfavorable prognostic factors. The objective of this study was to determine a safe negative margin width in Pakistani population that undergoes BCT.

Methods

A total of 603 patients with identifiable surgical margins underwent BCT from 1997 to 2009 in Shaukat Khanum Cancer Hospital. Patients were divided into close (≤2 mm), free (>2–10 mm), and wide (>10 mm) margin groups. Locoregional recurrence was defined as recurrence within the operated breast, ipsilateral axilla, or supraclavicular or internal mammary lymph nodes. Locoregional recurrence-free survival was calculated from the date of surgery to the date of locoregional recurrence. Five-year locoregional recurrence-free survival was determined for margin groups. Univariate and multivariate Cox proportional hazard analyses were performed to determine independent predictors of locoregional recurrence.

Results

A total of 415 (69 %) patients were <50 years of age. There were 82 (15 %) T3/T4, 337 (56 %) poorly differentiated, and 238 (39 %) ER/PR −ve tumors. Nodal positivity was present in 314 (52 %) patients. The actual number of locoregional recurrences was 16 (12 %), 8 (3 %), and 10 (4.6 %), respectively (P = 0.002). Expected 5-year locoregional recurrence-free survival was 90, 97, and 96 %, respectively (P = 0.002). On multivariate analysis, tumor size, nodal involvement, and negative margin width were independent predictors of locoregional recurrence.

Conclusion

A negative margin width of 2 mm might represent an adequate negative margin width in the Pakistani population undergoing breast conservative therapy.

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Conflicts of interest

The authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan

    Abu Bakar Bhatti, Amina Khan, Aamir Syed & Awais Aamir

  2. Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan

    Narjis Muzaffar & Neelam Siddiqui

  3. Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan

    Mazhar Shah & Arif Jamshed

Authors
  1. Abu Bakar Bhatti
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  2. Amina Khan
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  3. Narjis Muzaffar
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  4. Neelam Siddiqui
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  5. Aamir Syed
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  6. Mazhar Shah
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  7. Awais Aamir
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  8. Arif Jamshed
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Correspondence to Abu Bakar Bhatti.

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Bhatti, A.B., Khan, A., Muzaffar, N. et al. Safe Negative Margin Width in Breast Conservative Therapy: Results from a Population with a High Percentage of Negative Prognostic Factors. World J Surg 38, 2863–2870 (2014). https://doi.org/10.1007/s00268-014-2651-7

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  • DOI: https://doi.org/10.1007/s00268-014-2651-7

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