Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy
There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We review the evidence on surgical margins in BCT for early-stage invasive breast cancer. Meta-analysis of studies reporting local recurrence (LR) relative to quantified final microscopic margin s...
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| Published in | European journal of cancer (1990) Vol. 46; no. 18; pp. 3219 - 3232 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Kidlington
Elsevier Ltd
01.12.2010
Elsevier |
| Subjects | |
| Online Access | Get full text |
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| Abstract | There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We review the evidence on surgical margins in BCT for early-stage invasive breast cancer.
Meta-analysis of studies reporting local recurrence (LR) relative to quantified final microscopic margin
status and the threshold
distance for negative margins. The proportion of LR was modelled using random effects logistic meta-regression.
Based on 21 studies (LR in 1,026 of 14,571 subjects) the odds of LR were associated with margin
status [model 1: odds ratio (OR)
=
2.02 for positive/close versus negative; model 2: OR
=
1.80 for close versus negative, 2.42 for positive versus negative (
P
<
0.001 both models)] but not with margin
distance [1
mm versus 2
mm versus 5
mm (
P
>
0.10 both models)], adjusting for median follow-up time. However, there was weak evidence in
both models that the odds of LR decreased as the threshold distance for declaring negative margins increased. This bordered significance in model 2 [OR for 1
mm, 2
mm, 5
mm: 1.0, 0.75, 0.51 (
P
=
0.097 for trend)], and was not significant in model 1 [OR for 1
mm, 2
mm, 5
mm: 1.0, 0.85, 0.58 (
P
=
0.11 for trend)] but was evident when one study (of women
⩽
40
years) was excluded from this model [OR for 1
mm, 2
mm, 5
mm: 1.0, 0.72, 0.52 (
P
=
0.058 for trend)]: this trend was rendered
insignificant by adjustment for the proportion of subjects receiving a radiation boost or the proportion of subjects receiving endocrine therapy.
Margin
status has a prognostic effect in all women treated for invasive breast cancer; increasing the threshold
distance for declaring negative margins is weakly associated with reduced odds of LR, however adjustment for covariates (adjuvant therapy) removes the significance of this effect. Adoption of wider margins, relative to narrower widths, for declaring negative margins is unlikely to a have substantial additional benefit for
long-term local control in BCT. |
|---|---|
| AbstractList | There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We review the evidence on surgical margins in BCT for early-stage invasive breast cancer.
Meta-analysis of studies reporting local recurrence (LR) relative to quantified final microscopic margin status and the threshold distance for negative margins. The proportion of LR was modelled using random effects logistic meta-regression.
Based on 21 studies (LR in 1,026 of 14,571 subjects) the odds of LR were associated with margin status [model 1: odds ratio (OR) = 2.02 for positive/close versus negative; model 2: OR = 1.80 for close versus negative, 2.42 for positive versus negative (P<0.001 both models)] but not with margin distance [1mm versus 2mm versus 5mm (P > 0.10 both models)], adjusting for median follow-up time. However, there was weak evidence in both models that the odds of LR decreased as the threshold distance for declaring negative margins increased. This bordered significance in model 2 [OR for 1mm, 2mm, 5mm: 1.0, 0.75, 0.51 (P = 0.097 for trend)], and was not significant in model 1 [OR for 1mm, 2mm, 5mm: 1.0, 0.85, 0.58 (P = 0.11 for trend)] but was evident when one study (of women ≤ 40 years) was excluded from this model [OR for 1mm, 2mm, 5mm: 1.0, 0.72, 0.52 (P = 0.058 for trend)]: this trend was rendered insignificant by adjustment for the proportion of subjects receiving a radiation boost or the proportion of subjects receiving endocrine therapy.
Margin status has a prognostic effect in all women treated for invasive breast cancer; increasing the threshold distance for declaring negative margins is weakly associated with reduced odds of LR, however adjustment for covariates (adjuvant therapy) removes the significance of this effect. Adoption of wider margins, relative to narrower widths, for declaring negative margins is unlikely to a have substantial additional benefit for long-term local control in BCT. Abstract Purpose There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We review the evidence on surgical margins in BCT for early-stage invasive breast cancer. Methods Meta-analysis of studies reporting local recurrence (LR) relative to quantified final microscopic margin status and the threshold distance for negative margins. The proportion of LR was modelled using random effects logistic meta-regression. Results Based on 21 studies (LR in 1,026 of 14,571 subjects) the odds of LR were associated with margin status [model 1: odds ratio (OR) = 2.02 for positive/close versus negative; model 2: OR = 1.80 for close versus negative, 2.42 for positive versus negative ( P < 0.001 both models)] but not with margin distance [1 mm versus 2 mm versus 5 mm ( P > 0.10 both models)], adjusting for median follow-up time. However, there was weak evidence in both models that the odds of LR decreased as the threshold distance for declaring negative margins increased. This bordered significance in model 2 [OR for 1 mm, 2 mm, 5 mm: 1.0, 0.75, 0.51 ( P = 0.097 for trend)], and was not significant in model 1 [OR for 1 mm, 2 mm, 5 mm: 1.0, 0.85, 0.58 ( P = 0.11 for trend)] but was evident when one study (of women ⩽ 40 years) was excluded from this model [OR for 1 mm, 2 mm, 5 mm: 1.0, 0.72, 0.52 ( P = 0.058 for trend)]: this trend was rendered insignificant by adjustment for the proportion of subjects receiving a radiation boost or the proportion of subjects receiving endocrine therapy. Conclusions Margin status has a prognostic effect in all women treated for invasive breast cancer; increasing the threshold distance for declaring negative margins is weakly associated with reduced odds of LR, however adjustment for covariates (adjuvant therapy) removes the significance of this effect. Adoption of wider margins, relative to narrower widths, for declaring negative margins is unlikely to a have substantial additional benefit for long-term local control in BCT. There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We review the evidence on surgical margins in BCT for early-stage invasive breast cancer. Meta-analysis of studies reporting local recurrence (LR) relative to quantified final microscopic margin status and the threshold distance for negative margins. The proportion of LR was modelled using random effects logistic meta-regression. Based on 21 studies (LR in 1,026 of 14,571 subjects) the odds of LR were associated with margin status [model 1: odds ratio (OR) = 2.02 for positive/close versus negative; model 2: OR = 1.80 for close versus negative, 2.42 for positive versus negative ( P < 0.001 both models)] but not with margin distance [1 mm versus 2 mm versus 5 mm ( P > 0.10 both models)], adjusting for median follow-up time. However, there was weak evidence in both models that the odds of LR decreased as the threshold distance for declaring negative margins increased. This bordered significance in model 2 [OR for 1 mm, 2 mm, 5 mm: 1.0, 0.75, 0.51 ( P = 0.097 for trend)], and was not significant in model 1 [OR for 1 mm, 2 mm, 5 mm: 1.0, 0.85, 0.58 ( P = 0.11 for trend)] but was evident when one study (of women ⩽ 40 years) was excluded from this model [OR for 1 mm, 2 mm, 5 mm: 1.0, 0.72, 0.52 ( P = 0.058 for trend)]: this trend was rendered insignificant by adjustment for the proportion of subjects receiving a radiation boost or the proportion of subjects receiving endocrine therapy. Margin status has a prognostic effect in all women treated for invasive breast cancer; increasing the threshold distance for declaring negative margins is weakly associated with reduced odds of LR, however adjustment for covariates (adjuvant therapy) removes the significance of this effect. Adoption of wider margins, relative to narrower widths, for declaring negative margins is unlikely to a have substantial additional benefit for long-term local control in BCT. There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We review the evidence on surgical margins in BCT for early-stage invasive breast cancer.PURPOSEThere is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We review the evidence on surgical margins in BCT for early-stage invasive breast cancer.Meta-analysis of studies reporting local recurrence (LR) relative to quantified final microscopic margin status and the threshold distance for negative margins. The proportion of LR was modelled using random effects logistic meta-regression.METHODSMeta-analysis of studies reporting local recurrence (LR) relative to quantified final microscopic margin status and the threshold distance for negative margins. The proportion of LR was modelled using random effects logistic meta-regression.Based on 21 studies (LR in 1,026 of 14,571 subjects) the odds of LR were associated with margin status [model 1: odds ratio (OR) = 2.02 for positive/close versus negative; model 2: OR = 1.80 for close versus negative, 2.42 for positive versus negative (P<0.001 both models)] but not with margin distance [1mm versus 2mm versus 5mm (P > 0.10 both models)], adjusting for median follow-up time. However, there was weak evidence in both models that the odds of LR decreased as the threshold distance for declaring negative margins increased. This bordered significance in model 2 [OR for 1mm, 2mm, 5mm: 1.0, 0.75, 0.51 (P = 0.097 for trend)], and was not significant in model 1 [OR for 1mm, 2mm, 5mm: 1.0, 0.85, 0.58 (P = 0.11 for trend)] but was evident when one study (of women ≤ 40 years) was excluded from this model [OR for 1mm, 2mm, 5mm: 1.0, 0.72, 0.52 (P = 0.058 for trend)]: this trend was rendered insignificant by adjustment for the proportion of subjects receiving a radiation boost or the proportion of subjects receiving endocrine therapy.RESULTSBased on 21 studies (LR in 1,026 of 14,571 subjects) the odds of LR were associated with margin status [model 1: odds ratio (OR) = 2.02 for positive/close versus negative; model 2: OR = 1.80 for close versus negative, 2.42 for positive versus negative (P<0.001 both models)] but not with margin distance [1mm versus 2mm versus 5mm (P > 0.10 both models)], adjusting for median follow-up time. However, there was weak evidence in both models that the odds of LR decreased as the threshold distance for declaring negative margins increased. This bordered significance in model 2 [OR for 1mm, 2mm, 5mm: 1.0, 0.75, 0.51 (P = 0.097 for trend)], and was not significant in model 1 [OR for 1mm, 2mm, 5mm: 1.0, 0.85, 0.58 (P = 0.11 for trend)] but was evident when one study (of women ≤ 40 years) was excluded from this model [OR for 1mm, 2mm, 5mm: 1.0, 0.72, 0.52 (P = 0.058 for trend)]: this trend was rendered insignificant by adjustment for the proportion of subjects receiving a radiation boost or the proportion of subjects receiving endocrine therapy.Margin status has a prognostic effect in all women treated for invasive breast cancer; increasing the threshold distance for declaring negative margins is weakly associated with reduced odds of LR, however adjustment for covariates (adjuvant therapy) removes the significance of this effect. Adoption of wider margins, relative to narrower widths, for declaring negative margins is unlikely to a have substantial additional benefit for long-term local control in BCT.CONCLUSIONSMargin status has a prognostic effect in all women treated for invasive breast cancer; increasing the threshold distance for declaring negative margins is weakly associated with reduced odds of LR, however adjustment for covariates (adjuvant therapy) removes the significance of this effect. Adoption of wider margins, relative to narrower widths, for declaring negative margins is unlikely to a have substantial additional benefit for long-term local control in BCT. |
| Author | Houssami, Nehmat Marinovich, M. Luke Brennan, Meagan E. Macaskill, Petra Irwig, Les Solin, Lawrence J. Dixon, J. Michael |
| Author_xml | – sequence: 1 givenname: Nehmat surname: Houssami fullname: Houssami, Nehmat email: nehmath@med.usyd.edu.au organization: Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia – sequence: 2 givenname: Petra surname: Macaskill fullname: Macaskill, Petra organization: Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia – sequence: 3 givenname: M. Luke surname: Marinovich fullname: Marinovich, M. Luke organization: Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia – sequence: 4 givenname: J. Michael surname: Dixon fullname: Dixon, J. Michael organization: Breakthrough Research Unit Edinburgh, Western General Hospital, Edinburgh, Scotland, United Kingdom – sequence: 5 givenname: Les surname: Irwig fullname: Irwig, Les organization: Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia – sequence: 6 givenname: Meagan E. surname: Brennan fullname: Brennan, Meagan E. organization: Screening and Test Evaluation Program (STEP), School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia – sequence: 7 givenname: Lawrence J. surname: Solin fullname: Solin, Lawrence J. organization: Department of Radiation Oncology, Albert Einstein Medical Center, Philadelphia, PA, USA |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23652800$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/20817513$$D View this record in MEDLINE/PubMed |
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| Keywords | Invasive breast cancer Breast-conserving therapy Local recurrence Surgical margins Radiation therapy Surgical oncology Meta-analysis Relapse Breast disease Early stage Metaanalysis Cancerology Surgery Adult Female Surgical margin Invasive cancer Mammary gland Woman Human Breast cancer Malignant tumor Radiotherapy Mammary gland diseases Treatment Cancer |
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| Snippet | There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We review the evidence on surgical margins in BCT for... Abstract Purpose There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We review the evidence on surgical... |
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| SubjectTerms | Biological and medical sciences Breast Neoplasms - drug therapy Breast Neoplasms - pathology Breast Neoplasms - radiotherapy Breast Neoplasms - surgery Breast-conserving therapy Female Hematology, Oncology and Palliative Medicine Humans Invasive breast cancer Local recurrence Lymphatic Metastasis Mastectomy, Segmental - methods Medical sciences Meta-analysis Neoplasm Recurrence, Local - etiology Pharmacology. Drug treatments Radiation therapy Randomized Controlled Trials as Topic Surgical margins Surgical oncology Tumors |
| Title | Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy |
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