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

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

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Although considerable evidence exists regarding margin status and reexcision for patients undergoing breast conservation therapy, few data address the impact of a close margin for patients undergoing mastectomy without postmastectomy radiotherapy.Methods: This retrospective review identified 1147 patients who underwent 1206 mastectomies with negative final margins for breast cancer from 2006 to 2010. Margin distance was analyzed as a continuous variable and dichotomized variable ((≤2 vs >2 mm). Patients undergoing adjuvant radiation therapy were excluded from the study. Uni- and multivariable analyses were used to assess the association of reexcision, proximity of the final margin, adjuvant therapy, and other clinical and pathologic factors with local recurrence (LR). Results: In 158 mastectomies (13.1%), a reexcision was performed for a close (n = 90) or positive (n = 68) margin. All but one were identified intraoperatively using frozen section analysis. The reexcision rates for skin- and nipple-sparing mastectomy (SSM/NSM) were higher than for simple mastectomy (SM) (19.8 vs 9.3%; p < 0.001). The overall 5-year risk for an LR was 3.8%. The risk was 3.1% for a margin greater than 2 mm and 11.2% for a margin of 2 mm or smaller. In the multivariable model, proximity of the final margin measured as a continuous variable was found to be a significant risk factor for LR (p = 0.009), whereas adjuvant endocrine therapy was found to be protective (p = 0.03). Intraoperative reexcision was not significant in the multivariable model (p = 0.23). Conclusions: For patients undergoing mastectomy for breast cancer, a wider final margin correlated with a reduced risk for LR. The rates for LR were similar between SSM/NSM and SM despite higher rates of intraoperative reexcision for SSM/NSM.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Jul 5 2017

Fingerprint

Adjuvant Radiotherapy
Mastectomy
Recurrence
Simple Mastectomy
Radiotherapy
Breast Neoplasms
Segmental Mastectomy
Nipples
Frozen Sections
Skin
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Margin Proximity Correlates with Local Recurrence After Mastectomy for Patients Not Receiving Adjuvant Radiotherapy. / Glorioso, Jaime M.; Gonzalez Juarrero, Alexandra B.; Rodysill, Brian R.; Harmsen, William S.; Habermann, Elizabeth B; Carter, Jodi; Mutter, Robert; Degnim, Amy C; Jakub, James W.

In: Annals of Surgical Oncology, 05.07.2017, p. 1-9.

Research output: Contribution to journalArticle

@article{51ce2c18dca84650b570885962eedb62,
title = "Margin Proximity Correlates with Local Recurrence After Mastectomy for Patients Not Receiving Adjuvant Radiotherapy",
abstract = "Background: Although considerable evidence exists regarding margin status and reexcision for patients undergoing breast conservation therapy, few data address the impact of a close margin for patients undergoing mastectomy without postmastectomy radiotherapy.Methods: This retrospective review identified 1147 patients who underwent 1206 mastectomies with negative final margins for breast cancer from 2006 to 2010. Margin distance was analyzed as a continuous variable and dichotomized variable ((≤2 vs >2 mm). Patients undergoing adjuvant radiation therapy were excluded from the study. Uni- and multivariable analyses were used to assess the association of reexcision, proximity of the final margin, adjuvant therapy, and other clinical and pathologic factors with local recurrence (LR). Results: In 158 mastectomies (13.1{\%}), a reexcision was performed for a close (n = 90) or positive (n = 68) margin. All but one were identified intraoperatively using frozen section analysis. The reexcision rates for skin- and nipple-sparing mastectomy (SSM/NSM) were higher than for simple mastectomy (SM) (19.8 vs 9.3{\%}; p < 0.001). The overall 5-year risk for an LR was 3.8{\%}. The risk was 3.1{\%} for a margin greater than 2 mm and 11.2{\%} for a margin of 2 mm or smaller. In the multivariable model, proximity of the final margin measured as a continuous variable was found to be a significant risk factor for LR (p = 0.009), whereas adjuvant endocrine therapy was found to be protective (p = 0.03). Intraoperative reexcision was not significant in the multivariable model (p = 0.23). Conclusions: For patients undergoing mastectomy for breast cancer, a wider final margin correlated with a reduced risk for LR. The rates for LR were similar between SSM/NSM and SM despite higher rates of intraoperative reexcision for SSM/NSM.",
author = "Glorioso, {Jaime M.} and {Gonzalez Juarrero}, {Alexandra B.} and Rodysill, {Brian R.} and Harmsen, {William S.} and Habermann, {Elizabeth B} and Jodi Carter and Robert Mutter and Degnim, {Amy C} and Jakub, {James W}",
year = "2017",
month = "7",
day = "5",
doi = "10.1245/s10434-017-5968-2",
language = "English (US)",
pages = "1--9",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
publisher = "Springer New York",

}

TY - JOUR

T1 - Margin Proximity Correlates with Local Recurrence After Mastectomy for Patients Not Receiving Adjuvant Radiotherapy

AU - Glorioso, Jaime M.

AU - Gonzalez Juarrero, Alexandra B.

AU - Rodysill, Brian R.

AU - Harmsen, William S.

AU - Habermann, Elizabeth B

AU - Carter, Jodi

AU - Mutter, Robert

AU - Degnim, Amy C

AU - Jakub, James W

PY - 2017/7/5

Y1 - 2017/7/5

N2 - Background: Although considerable evidence exists regarding margin status and reexcision for patients undergoing breast conservation therapy, few data address the impact of a close margin for patients undergoing mastectomy without postmastectomy radiotherapy.Methods: This retrospective review identified 1147 patients who underwent 1206 mastectomies with negative final margins for breast cancer from 2006 to 2010. Margin distance was analyzed as a continuous variable and dichotomized variable ((≤2 vs >2 mm). Patients undergoing adjuvant radiation therapy were excluded from the study. Uni- and multivariable analyses were used to assess the association of reexcision, proximity of the final margin, adjuvant therapy, and other clinical and pathologic factors with local recurrence (LR). Results: In 158 mastectomies (13.1%), a reexcision was performed for a close (n = 90) or positive (n = 68) margin. All but one were identified intraoperatively using frozen section analysis. The reexcision rates for skin- and nipple-sparing mastectomy (SSM/NSM) were higher than for simple mastectomy (SM) (19.8 vs 9.3%; p < 0.001). The overall 5-year risk for an LR was 3.8%. The risk was 3.1% for a margin greater than 2 mm and 11.2% for a margin of 2 mm or smaller. In the multivariable model, proximity of the final margin measured as a continuous variable was found to be a significant risk factor for LR (p = 0.009), whereas adjuvant endocrine therapy was found to be protective (p = 0.03). Intraoperative reexcision was not significant in the multivariable model (p = 0.23). Conclusions: For patients undergoing mastectomy for breast cancer, a wider final margin correlated with a reduced risk for LR. The rates for LR were similar between SSM/NSM and SM despite higher rates of intraoperative reexcision for SSM/NSM.

AB - Background: Although considerable evidence exists regarding margin status and reexcision for patients undergoing breast conservation therapy, few data address the impact of a close margin for patients undergoing mastectomy without postmastectomy radiotherapy.Methods: This retrospective review identified 1147 patients who underwent 1206 mastectomies with negative final margins for breast cancer from 2006 to 2010. Margin distance was analyzed as a continuous variable and dichotomized variable ((≤2 vs >2 mm). Patients undergoing adjuvant radiation therapy were excluded from the study. Uni- and multivariable analyses were used to assess the association of reexcision, proximity of the final margin, adjuvant therapy, and other clinical and pathologic factors with local recurrence (LR). Results: In 158 mastectomies (13.1%), a reexcision was performed for a close (n = 90) or positive (n = 68) margin. All but one were identified intraoperatively using frozen section analysis. The reexcision rates for skin- and nipple-sparing mastectomy (SSM/NSM) were higher than for simple mastectomy (SM) (19.8 vs 9.3%; p < 0.001). The overall 5-year risk for an LR was 3.8%. The risk was 3.1% for a margin greater than 2 mm and 11.2% for a margin of 2 mm or smaller. In the multivariable model, proximity of the final margin measured as a continuous variable was found to be a significant risk factor for LR (p = 0.009), whereas adjuvant endocrine therapy was found to be protective (p = 0.03). Intraoperative reexcision was not significant in the multivariable model (p = 0.23). Conclusions: For patients undergoing mastectomy for breast cancer, a wider final margin correlated with a reduced risk for LR. The rates for LR were similar between SSM/NSM and SM despite higher rates of intraoperative reexcision for SSM/NSM.

UR - http://www.scopus.com/inward/record.url?scp=85021822883&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021822883&partnerID=8YFLogxK

U2 - 10.1245/s10434-017-5968-2

DO - 10.1245/s10434-017-5968-2

M3 - Article

SP - 1

EP - 9

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

ER -