原发性可手术乳腺癌手术切缘、再次手术、残余癌相关临床病理因素

　　确定哪些患者的手术切缘阳性风险较高，有助于提高临床术前决策水平，并且降低再次手术率。

　　2018年8月1日，欧洲肿瘤外科学会《欧洲肿瘤外科杂志》在线发表中国台湾彰化基督教医院、台北阳明大学、台中中山医学大学、台北天主教耕莘医院、台中乌日林新医院、高雄医学大学的研究报告，对原发性可手术乳腺癌的手术切缘受累、再次手术、残余癌相关临床病理因素进行了分析。

　　该回顾研究分析了2050例接受保乳手术或乳房切除手术治疗原发性可手术乳腺癌女性队列的手术切缘阳性、再次切除需求、再次切除标本检出残余癌相关因素。

　　结果发现，手术切缘阳性患者151例（7.4%）。1042例保乳手术患者、1008例乳房切除手术患者的手术切缘阳性发生率分别为11.3%、3.3%（P<0.001）。

　　根据多因素分析，保乳手术患者手术切缘阳性相关因素：患者体重指数较低、肿瘤较大、病理学证实多灶病变。再次手术风险较高相关因素：年龄较小、组织学亚型为乳腺导管原位癌（比值比：2.165，95%置信区间：1.253～4.323）。

　　术前接受磁共振检查的保乳手术患者：

• 切缘受累风险较低（比值比：0.530，95%置信区间：0.332～0.842）

• 再次手术风险较低（比值比：0.302，95%置信区间：0.119～0.728）

　　组织学亚型为乳腺导管原位癌与其他类型乳腺癌相比，残余癌发生风险较高。

　　因此，手术切缘阳性受累风险增加相关因素包括患者体重指数较低、肿瘤较大、病理学证实多灶病变、术前未接受磁共振检查，再次手术和再次切除检出残余癌风险增加相关因素为乳腺导管原位癌手术切缘阳性。

Eur J Surg Oncol. 2018 Aug 1. [Epub ahead of print]

Clinicopathologic factors related to surgical margin involvement, reoperation, and residual cancer in primary operable breast cancer- An analysis of 2050 patients.

Hung-Wen Lai, Ren-Hung Huang, Yu-Ting Wu, Chih-Jung Chen, Shou-Tung Chen, Ying-Jen Lin, Dar-Ren Chen, Chih-Wei Lee, Hwa-Koon Wu, Hui-Yu Lin, Shou-Jen Kuo.

Changhua Christian Hospital, Changhua, Taiwan; National Yang Ming University, Taipei, Taiwan; Chung Shan Medical University, Taichung, Taiwan; Cardinal Tien Hospital, Taipei, Taiwan; Wuri Lin Shin Hospital, Taichung, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan.

BACKGROUND: To evaluate whether clinicopathologic factors are related to surgical margin involvement, reoperation, and residual cancer in primary operable breast cancer.

METHODS: Identification of patients at increased risk for positive surgical margins may enhance clinical preoperative decision-making and lower the reoperation rate. In this retrospective study, we analyzed the factors associated with positive surgical margins, the need for re-excision, and residual cancer detection in re-excised specimens in a cohort of 2050 women who underwent either breast-conserving surgery (BCS) or mastectomy for primary operable breast cancer.

RESULTS: Positive surgical margins were detected in 151 (7.4%) of the 2050 patients. The incidence of positive surgical margins was 11.3% (118/1042) in the BCS group and 3.3% (33/1008) in the mastectomy group (P<0.001). In multivariate analysis, lower body mass index (BMI), larger tumor size, and pathologic evidence of multifocal disease were associated with positive surgical margin involvement in the BCS group. Younger age and ductal carcinoma in situ (DCIS) histologic subtypes (Odds ratio(OR)=2.165, 95% CI=1.253～4.323) were associated with higher risk of re-operations. Preoperative MRI examination was associated with decreased risk for margin involvement in the BCS group (OR=0.530, 95% CI=0.332～0.842) and reoperation (OR=0.302, 95% CI=0.119～0.728). DCIS histologic subtypes were associated with higher residual tumor incidence than other types of breast cancer.

CONCLUSIONS: Lower BMI, larger tumor size, pathologic evidence of multifocal disease, and no preoperative MRI evaluation were associated with increased risk for positive surgical margin involvement. DCIS with positive surgical margins was associated with increased risk for reoperation and residual cancer detection at re-excision.

KEYWORDS: breast cancer, surgical margin, magnetic resonance imaging (MRI), breast-conserving surgery (BCS), mastectomy, ductal carcinoma in situ

DOI: 10.1016/j.ejso.2018.07.056