Margin Proximity Correlates with Local Recurrence After Mastectomy for Patients Not Receiving Adjuvant Radiotherapy

Glorioso, Jaime; Juarrero, Alexandra B Gonzalez; Rodysill, Brian; Harmsen, William S.; Habermann, Elizabeth B.; Carter, Jodi M.; Mutter, Robert W.; Degnim, Amy C.; Jakub, James W.

doi:10.1245/s10434-017-5968-2

Cited by 14 publications

(10 citation statements)

References 20 publications

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“…The locoregional recurrence of this population was 3.0%, with a median follow‐up time of 39 (IQR: 21–59) months. This is in accordance with results reported for sparing mastectomies in the literature 17,21,26–29 . Agha et al 30 reported on a metanalysis of SSMs and NSMs a local recurrence rate of 3.3% and 3.9%, respectively.…”

Section: Discussionsupporting

confidence: 90%

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Locoregional recurrence in skin‐sparing and nipple‐sparing mastectomies

Costeira¹,

Silva²,

Oom³

et al. 2021

Journal of Surgical Oncology

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Background Skin‐ and nipple‐sparing mastectomies (SSMs/NSMs) present as an alternative for patients requiring mastectomy, with better aesthetic results. We aimed to evaluate the locoregional recurrence (LRR) rate and its predictive factors. Methods Retrospective analysis of all consecutive cases of SSM and NSM for a primary diagnosis of in situ or invasive breast cancer, at a national cancer center, from January 1st, 2013 to May 31st, 2019. The primary outcome was LRR. Secondary outcomes included LRR predictive factors, overall survival (OS), and disease‐free survival (DFS). Results There were included 461 patients; 402 (87%) with invasive carcinoma. The median age was 46 (interquartile range [IQR]: 40–53) years. Ninety (20%) patients had locally advanced disease. LRR rate was 3.0%, with a median follow‐up time of 39 (IQR: 21–59) months. The median time to recurrence was 22 (IQR: 10–45) months. Factors independently associated with LRR were high histological grade, negative estrogen receptor status, and high Ki67 (p < 0.05). OS was 94.8% and DFS was 92.8%. LRR was associated with decreased OS. Discussion SSM and NSM present as a safe approach to breast cancer requiring mastectomy, including selected patients with a locally advanced tumor. The associated LRR rate is 3.0%, with risk factors being high grade, negative estrogen receptor status, and high Ki67.

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Section: Discussionsupporting

confidence: 90%

“…Some studies in the literature associate close tumor margins with locoregional recurrence, namely in breast cancer surgery 29,38 . In our analysis, the close margin was not a locoregional recurrence risk factor ( p = 0.69).…”

Section: Discussionmentioning

confidence: 43%

Locoregional recurrence in skin‐sparing and nipple‐sparing mastectomies

Costeira¹,

Silva²,

Oom³

et al. 2021

Journal of Surgical Oncology

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“…During the discussion, it became obvious that there are wide international variations in clinical practice concerning positive or close margins after NSM, ranging from further surgery to post-mastectomy radiotherapy to no treatment. A large patient series at Mayo Clinic showed that the overall 5-year risk of local recurrence was higher in patients with a margin ≤ 2 mm compared to a margin > 2 mm (11.2% vs. 3.1%), with the proximity of the final margin being an independent significant risk factor for local recurrence [ 45 ]. However, in a retrospective single-center study of 64 SSM procedures with a positive mastectomy margin towards the skin in the area of the primary tumor, only 13 (20%) had residual cancer in simultaneous re-excisions of the subcutaneous tissue, suggesting a high incidence of false-positive margins [ 16 ].…”

Section: Resultsmentioning

confidence: 99%

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Weber

Haug

Kurzeder

et al. 2018

Breast Cancer Res Treat

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PurposeIndications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion.MethodsThe panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology.ResultsConsensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference.ConclusionsIn case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques.Electronic supplementary materialThe online version of this article (10.1007/s10549-018-4937-1) contains supplementary material, which is available to authorized users.

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“…4 studies additionally reported hazard ratios for distant disease-free recurrence. The association between margin status and LR was reported in 7 studies (4,15,20,28,36,39,44). In the univariable analyses, positive or close margins were associated with increased LR (HR 2•88 (95% CI 2•06,4•03)) (Supplementary Figure 1).…”

Section: Reporting Standards and Methodological Qualitymentioning

confidence: 88%