The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis.

Abstract

PURPOSE:

There is no consensus on adequate negative margins in breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS). We systematically reviewed the evidence on margins in BCS for DCIS.

METHODS:

A study-level meta-analysis of local recurrence (LR), microscopic margin status and threshold distance for negative margins. LR proportion was modeled using random-effects logistic meta-regression (frequentist) and network meta-analysis (Bayesian) that allows for multiple margin distances per study, adjusting for follow-up time.

RESULTS:

Based on 20 studies (LR: 865 of 7883), odds of LR were associated with margin status [logistic: odds ratio (OR) 0.53 for negative vs. positive/close (p < 0.001); network: OR 0.45 for negative vs. positive]. In logistic meta-regression, relative to >0 or 1 mm, ORs for 2 mm (0.51), 3 or 5 mm (0.42) and 10 mm (0.60) showed comparable significant reductions in the odds of LR. In the network analysis, ORs relative to positive margins for 2 (0.32), 3 (0.30) and 10 mm (0.32) showed similar reductions in the odds of LR that were greater than for >0 or 1 mm (0.45). There was weak evidence of lower odds at 2 mm compared with >0 or 1 mm [relative OR (ROR) 0.72, 95 % credible interval (CrI) 0.47-1.08], and no evidence of a difference between 2 and 10 mm (ROR 0.99, 95 % CrI 0.61-1.64). Adjustment for covariates, and analyses based only on studies using whole-breast radiotherapy, did not change the findings.

CONCLUSION:

Negative margins in BCS for DCIS reduce the odds of LR; however, minimum margin distances above 2 mm are not significantly associated with further reduced odds of LR in women receiving radiation.

• Authors: M Luke Marinovich, Lamiae Azizi, Petra Macaskill, Les Irwig, Monica Morrow, Lawrence J Solin, Nehmat Houssami
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 23 Issue 12 Pg. 3811-3821 (11 2016) ISSN: 1534-4681 [Electronic] United States
• PMID: 27527715 (Publication Type: Journal Article, Meta-Analysis, Review, Research Support, Non-U.S. Gov't)

Topics

• Breast Neoplasms (radiotherapy, surgery)
• Carcinoma, Intraductal, Noninfiltrating (radiotherapy, surgery)
• Female
• Humans
• Margins of Excision
• Mastectomy, Segmental
• Neoplasm Recurrence, Local
• Network Meta-Analysis
• Odds Ratio
• Organ Sparing Treatments
• Radiotherapy, Adjuvant