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Surgical margin status and survival outcomes of breast cancer patients treated with breast-conserving surgery and whole-breast irradiation after neoadjuvant chemotherapy

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Abstract

Purpose

The definition of "no tumor on ink" is generally applied for clear resection margin (RM) after breast-conserving surgery (BCS). However, few studies reported the effect of RM in the setting of neoadjuvant chemotherapy (NAC). We investigated the association between RM status and survival outcomes for those who underwent BCS after NAC for breast cancer.

Methods

We retrospectively reviewed the data of 2,803 patients who underwent BCS and whole-breast irradiation after NAC between January 2008 and December 2016 from three institutions in South Korea.

Results

The 786 patients in the pathologic complete response group (RpCR) had significantly longer local recurrence-free survival (LRFS) than the 1,949 patients in clear or close RM and non-pCR group (R0) and the 68 patients in involved RM and non-pCR group (R1) (vs. R0, p = 0.001; vs. R1, p = 0.049). Patients in R0 showed no benefit in LRFS compared to R1 on both log-rank test (HR = 1.20; 95% C.I., 0.49–2.93; p = 0.692) and Cox regression analysis (HR = 2.05; 95% C.I., 0.64–6.58; p = 0.227). Subgroup analysis according to tumor subtypes revealed that there was no significant difference in LRFS, distant metastasis-free survival, and recurrence-free survival between the R0 and R1 group. Additionally, among 286 patients with pCR with residual ductal carcinoma in situ (DCIS) alone, RM status was not significantly associated with LRFS.

Conclusion

Clear RM of specimen does not have benefit on LRFS after NAC. Additionally, for the patients showing pCR with residual DCIS in the breast, margin involvement also did not affect the risk of local recurrence.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to sincerely appreciate Mr. Yong Seop Lee and Ms. Sun Hee Kang for financial support to conduct research in the department of breast surgery, Samsung Medical Center. Additionally, we thank Dr. Sae Byul Lee, Jisun Kim, Il Yong Chung, Hee Jeong Kim, Beom Seok Ko, Jong Won Lee, Byung Ho Son, and Sei-hyun Ahn (Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea) for critical advice and consultation.

Funding

This study was conducted with the support of the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2018R1D1A1A09081884) and by the MSIT (Ministry of Science and ICT), Korea, under the ICT Creative Consilience program (IITP-2020–0-01821) supervised by the IITP (Institute for Information & communications Technology Planning & Evaluation) and by SMC-SKKU Future Convergence Program (Grant SMO1190341).

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Author notes

  1. Jong-Ho Cheun

    Present address: Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, South Korea

  2. Young Joo Lee

    Present address: Department of Surgery, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

  3. Jun-Hee Lee

    Present address: Department of Surgery, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital Seoul, Seoul, South Korea

  4. Jong-Ho Cheun, Young Joo Lee and Jun-Hee Lee have equally contributed to this work.

Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea

    Jong-Ho Cheun, Hong-Kyu Kim, Han-Byoel Lee & Wonshik Han

  2. Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

    Young Joo Lee, Yungil Shin, Jung Whan Chun & Soo Yeon Baek

  3. Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Jun-Hee Lee, Jonghan Yu, Byung Joo Chae & Jeong Eon Lee

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Contributions

All authors whose names appear on the submission made substantial contributions to the conception of design of the work or the acquisition, analysis, or interpretation or data; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jeong Eon Lee.

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Conflict of interest

Han-Byoel Lee and Wonshik Han report being a member on the board of directors of and holding stock and ownership interests at DCGen, Co., Ltd., not relevant to this study. Other authors declare no competing interests.

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The study was performed in accordance with the Declaration of Helsinki or comparable ethical standards. Approval was granted by the ethics committee or institutional review board at the participating sites.

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Cheun, JH., Lee, Y.J., Lee, JH. et al. Surgical margin status and survival outcomes of breast cancer patients treated with breast-conserving surgery and whole-breast irradiation after neoadjuvant chemotherapy. Breast Cancer Res Treat 194, 683–692 (2022). https://doi.org/10.1007/s10549-021-06500-4

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