Re-Excision Rate in Breast Conservation Surgery after Neoadjuvant Chemotherapy

송정현; 박정영; 최정은; 강수환; 이수정; 배연경

doi:https://doi.org/10.14449/jbd.2017.5.1.16

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자료유형: 학술저널

저자정보: 송정현 (영남대학교) 박정영 (영남대학교) 최정은 (영남대학교) 강수환 (영남대학교) 이수정 (영남대학교) 배연경 (영남대학교)

저널정보: 한국유방암학회 Journal of Breast Disease Journal of Breast Disease 제5권 제1호

발행연도: 2017.6

수록면: 16 - 22 (7page)

DOI: https://doi.org/10.14449/jbd.2017.5.1.16

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연구배경

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Purpose: The purpose of this study was to compare the success rate of re-excision and breast-conserving surgery (BCS) between patients who received neoadjuvant chemotherapy and those who did not. Methods: In this retrospective cohort study, 256 women who had clinical T2 breast cancer and planned to receive, as initial treatment either BCS (n=197) or neoadjuvant chemotherapy (n=59) between January 2009 and December 2012 were included. The data, including age, initial tumor size, mammographic microcalcification, ultrasound multifocality and axillary nodal status, were collected. The pathologic tumor size, p-multifocality, histologic type, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67, ductal carcinoma in situ (DCIS) and extensive intraductal component (EIC) were also reviewed. The re-excision and BCS success rates were investigated. Univariate analysis and regression model were used. To reduce the effect of selection bias, propensity score matching-based analysis was also performed. Results: Of the 256 patients, 178 patients (90.4%, 178/197) in the non-neoadjuvant group and 56 patients (94.9%, 56/59) in the neoadjuvant group received BCS (p=0.406). In propensity-matched cohorts (n=118), the re-excision rate was similar in the two groups (35.6% in neoadjuvant group vs. 35.6% in non-neoadjuvant group, p=1.000). BCS success rate was slightly higher in neoadjuvant group (94.9%, 56/59) than in non-neoadjuvant group (86.4% [51/59], p=0.205). In logistic regression model, clinicopathologic factors associated with re-excision were pathologic multifocality (odds ratio [OR], 4.56; p=0.0142), high Ki-67 (≥50%) (OR, 0.7; p=0.0243) and DCIS component (OR, 2.67; p=0.0261). Conclusion: This study showed that neoadjuvant chemotherapy could increase the success rate of BCS but could not decrease that of re-excision. The re-excision rate is more associated with pathologic finding rather than the effect of neoadjuvant chemotherapy.

#Breast neoplasms #Margins of excision #Neoadjuvant chemotherapy #Re-excision #Segmental mastectomy

참고문헌 (23)

참고문헌 신청

van Maaren MC / 2016 / 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study / Lancet Oncol 17:1158~1170

Ye JC / 2015 / Equivalent survival with mastectomy or breast-conserving surgery plus radiation in young women aged < 40 years with early-stage breast cancer: a national registry-based stage-by-stage comparison / Clin Breast Cancer 15:390~397

Agarwal S / 2014 / Effect of breast conservation therapy vs mastectomy on disease-specific survival for early-stage breast cancer / JAMA Surg 149:267~274

Veronesi U / 2002 / Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer / N Engl J Med 347:1227~1232

Russo AL / 2013 / Margin status and the risk of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy / Breast Cancer Res Treat 140:353~361

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