75 Background: There remains a controversy in literature regarding adequate width of negative surgical margins in breast conservative therapy (BCT). Majority of patients included in studies on outcomes of BCT had favorable prognostic factors. Pakistani population is known to have an elevated expression of unfavorable prognostic factors. This study was done to determine safe negative margin width in a patient population with significantly higher percentage of unfavorable prognostic factors undergoing BCT. Methods: A review of patients who received BCT from 1997-2009 at Shukat Khanum Cancer Hospital was performed. A total of 603 patients whose margin status could be assessed were included. Patients were divided into close ( ≤ 2mm), free (> 2-10mm), and wide (> 10mm) margin groups. Patient characteristics, medical treatment modalities, and number of locoregional recurrences were observed for each margin group. Chi square and Fisher’s exact test were used for categorical variables. Five year locoregional control was determined for margin groups. Univariate and multivariate Cox regression analysis was performed to determine independent predictors of locoregional recurrence. Results: Out of total, 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. A higher percentage of T3/T4 tumors in close margin group (25% versus 13% and 7%) (p < 0.0001) was observed. Use of neoadjuvant chemotherapy was significantly higher in close margin group (33% versus 29% and 16%) (p < 0.0001). The actual number of observed locoregional recurrences was 16 (12%), 8 (3%), and 10 (4.6%) in close, free, and wide margin groups (p = 0.002) while the expected 5 year locoregional control was 90%, 97%, and 96% (p = 0.002) respectively. On multivariate analysis tumor size stage, nodal involvement and negative margin width were independent predictors of locoregional failure. Conclusions: A negative margin width of 2mm might represent an adequate negative margin width in populations with a higher percentage of unfavorable prognostic factors.
70 Background: Triple-negative breast cancer represents a subgroup of breast cancer associated with aggressive behavior and high risk of local and regional failure. Aggressive surgical intervention is considered optimal for this cancer which has made role of Breast conservative therapy (BCT) debatable in these patients. The objective of this study was to compare outcome of BCT for triple negative versus non-triple–negative breast cancers. Methods: Data of patients who underwent breast conservative therapy between 1997-2009 at Shaukat Khanum Cancer Hospital and had complete receptor status information were extracted. Patients were divided into triple-negative breast cancer (TNBC) and non-TNBC. Patient characteristics, medical treatment modalities and adverse events between two groups were compared. Five year locoregional recurrence free, disease free and overall survival was calculated. Univariate and multivariate analysis was done to identify independent predictors of outcome. Results: A total of 194 patients with TNBC and 443 with non-TNBC were compared. Significant differences was present for age at presentation (p<0.0001), family history (p=0.005), grade (p<0.0001) and use of hormonal therapy (p<0.0001). The actual number of locoregional failures, distant failures, and mortalities were not significantly different. No significant difference was present in 5-year locoregional recurrence free (96% vs. 92%, p=0.3), disease free (75% vs. 74%, p=0.7) and overall survival (78% vs. 83%, p=0.2). Tumor size, nodal involvement and hormonal treatment were independent predictors of survival on multivariate analysis. Conclusions: Breast-conservative therapy has comparable outcomes for triple-negative and non-triple–negative breast cancers.
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