The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis
- 2k Downloads
There is no consensus on adequate negative margins in breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS). We systematically reviewed the evidence on margins in BCS for DCIS.
A study-level meta-analysis of local recurrence (LR), microscopic margin status and threshold distance for negative margins. LR proportion was modeled using random-effects logistic meta-regression (frequentist) and network meta-analysis (Bayesian) that allows for multiple margin distances per study, adjusting for follow-up time.
Based on 20 studies (LR: 865 of 7883), odds of LR were associated with margin status [logistic: odds ratio (OR) 0.53 for negative vs. positive/close (p < 0.001); network: OR 0.45 for negative vs. positive]. In logistic meta-regression, relative to >0 or 1 mm, ORs for 2 mm (0.51), 3 or 5 mm (0.42) and 10 mm (0.60) showed comparable significant reductions in the odds of LR. In the network analysis, ORs relative to positive margins for 2 (0.32), 3 (0.30) and 10 mm (0.32) showed similar reductions in the odds of LR that were greater than for >0 or 1 mm (0.45). There was weak evidence of lower odds at 2 mm compared with >0 or 1 mm [relative OR (ROR) 0.72, 95 % credible interval (CrI) 0.47–1.08], and no evidence of a difference between 2 and 10 mm (ROR 0.99, 95 % CrI 0.61–1.64). Adjustment for covariates, and analyses based only on studies using whole-breast radiotherapy, did not change the findings.
Negative margins in BCS for DCIS reduce the odds of LR; however, minimum margin distances above 2 mm are not significantly associated with further reduced odds of LR in women receiving radiation.
KeywordsLocal Recurrence Positive Margin Margin Status Online Appendix Negative Margin
M.L. Marinovich is supported by a Cancer Institute NSW (CINSW) Early Career Fellowship. N. Houssami receives research support via a National Breast Cancer Foundation (NBCF) Australia Breast Cancer Research Leadership Fellowship. This work was partly supported by a National Health and Medical Research Council (NHMRC) program Grant to the STEP.
- 7.Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol. 2014;32:1507–15.CrossRefPubMedGoogle Scholar
- 8.American Society of Breast Surgeons. The American Society of Breast Surgeons position statement on breast cancer lumpectomy margins. 2013. https://www.breastsurgeons.org/new_layout/about/statements/PDF_Statements/Lumpectomy_Margins.pdf. Accessed 28 Jul 2016.
- 9.National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology, breast cancer version 1. 2016. http://www.nccn.org. Accessed 14 Dec 2015.
- 10.National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and treatment: NICE guidelines [CG80]. 2009. https://www.nice.org.uk/guidance/cg80/chapter/guidance#surgery-to-the-breast. Accessed 14 Dec 2015.
- 11.New Zealand Guidelines Group (NZGG). Ductal carcinoma in situ. Management of early breast cancer: evidence-based best practice guideline. Wellington: New Zealand Guidelines Group; 2015. pp. 133–41.Google Scholar
- 13.Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology—American Society for Radiation Oncology—American Society of Clinical Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Ann Surg Oncol. 2016. doi: 10.1245/s10434-016-5449-z.Google Scholar
- 18.Vicini F, Beitsch P, Quiet C, et al. Five-year analysis of treatment efficacy and cosmesis by the American Society of Breast Surgeons mammosite breast brachytherapy registry trial in patients treated with accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2011;79:808–17.CrossRefPubMedGoogle Scholar
- 22.Rodrigues N, Carter D, Dillon D, Parisot N, Choi DH, Haffty BG. Correlation of clinical and pathologic features with outcome in patients with ductal carcinoma in situ of the breast treated with breast-conserving surgery and radiotherapy. Int J Radiat Oncol Biol Phys. 2002;54:1331–5.CrossRefPubMedGoogle Scholar
- 31.Bijker N, Meijnen P, Peterse JL, et al. Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853. A study by the EORTC breast cancer cooperative group and EORTC radiotherapy group. J Clin Oncol. 2006;24:3381–7.CrossRefPubMedGoogle Scholar
- 39.Jansen JP, Trikalinos T, Cappelleri JC, et al. Indirect treatment comparison/network meta-analysis study questionnaire to assess relevance and credibility to inform health care decision making: an ISPOR-AMCP-NPC good practice task force report. Value Health. 2014;17:157–73.CrossRefPubMedGoogle Scholar
- 44.Correa C, McGale P, Taylor C, et al. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast. J Natl Cancer Inst Monogr. 2010;162–77.Google Scholar
- 46.Tunon-De-Lara C, De-Mascarel I, Mac-Grogan G, et al. Analysis of 676 cases of ductal carcinoma in situ of the breast from 1971 to 1995: diagnosis and treatment. The experience of one institute. Am J Clin Oncol Cancer Clin Trials. 2001;24:531–36.Google Scholar