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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2024; 84(09): 837-844
DOI: 10.1055/a-2374-2270
GebFra Science
Original Article

Prognostic Impact of Surgical Margin Status on Overall Survival of Patients with Early Breast Cancer: A Retrospective Analysis from the Department for Women’s Medicine at Charité – University Hospital Berlin

Prognostische Auswirkung des Schnittrand-Status auf das Gesamtüberleben von Patientinnen mit Brustkrebs im Frühstadium: eine retrospektive Analyse aus der Abteilung für Frauenheilkunde an der Charité – Universitätsmedizin Berlin
Maximilian Heinz Beck 
1   Department of Gynecology with Breast Center, Campus Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany (Ringgold ID: RIN14903)
2   Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany (Ringgold ID: RIN14903)
,
Karoline Barbara Stephanie Weiler
1   Department of Gynecology with Breast Center, Campus Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany (Ringgold ID: RIN14903)
,
Anna Trelinska-Finger
3   Cancer Registry Charité, Comprehensive Cancer Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany (Ringgold ID: RIN14903)
,
Jens-Uwe Blohmer
1   Department of Gynecology with Breast Center, Campus Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany (Ringgold ID: RIN14903)
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Abstract

Introduction

The impact of surgical margins on the prognosis of early breast cancer remains uncertain, particularly in the context of modern treatment approaches. This study aimed to investigate whether involved margins after surgery for early breast cancer affect overall survival.

Methods

We conducted a retrospective analysis of 3767 patients who underwent surgery for primary breast cancer or carcinoma in situ between 2006 and 2022 at Charité – University Hospital Berlin. Survival analysis based on margin status and a subsequent multivariate Cox regression analysis were conducted.

Results

With a median follow-up of 72.2 months, clear margins were achieved in 81.4% of patients (n = 3068) after primary surgery, while 16.2% (n = 610) required re-excision. Only 2.4% of patients (n = 89) had definitively involved margins. Margin involvement was more common in hormone receptor-positive disease, lobular subtype, carcinoma in situ, or locally advanced tumors, but less frequent in patients with previous neoadjuvant chemotherapy or triple-negative breast cancer. The Kaplan–Meier survival curves showed a significant separation with worse outcomes for patients with definitive R1 resections. However, the multivariate Cox regression analysis detected no statistically significant difference in overall survival based on margin status. Breast conserving surgery (HR 0.66; 95% CI 0.54–0.81) and HER2 overexpression (HR 0.65; 95% CI 0.48–0.89) were associated with improved survival.

Conclusion

Patients who underwent breast-conserving surgery in our study demonstrated favorable outcomes compared to patients after mastectomy. Although margin status did not significantly affect overall survival, larger multicenter studies are needed to evaluate the prognostic implications of margin involvement in breast cancer treatment in different tumor stages, tumor subtypes and local and systemic treatments.

Zusammenfassung

Einleitung

Die Auswirkung des Schnittrand-Status auf die Prognose von Brustkrebs im Frühstadium ist immer noch unklar, insbesondere in Rahmen moderner Behandlungsansätze. Ziel der Studie war es, zu untersuchen, wie sich positive Schnittränder nach einer Operation zur Behandlung vom Mammakarzinom im Frühstadium auf das Gesamtüberleben auswirken.

Methoden

Es wurde eine retrospektive Analyse von 3767 Patientinnen, die wegen primärem Brustkrebs oder Carcinoma in situ zwischen 2006 und 2022 in der Charité – Universitätsmedizin Berlin operiert wurden, durchgeführt. Dazu wurde eine Überlebensanalyse hinsichtlich des Schnittrand-Status sowie eine multivariate Cox-Regressionsanalyse durchgeführt.

Ergebnisse

Die mediane Verlaufskontrolle betrug 72,2 Monate. Bei 81,4% der Patientinnen (n = 3068) waren die Schnittränder nach der primären Operation negativ, wohingegen 16,2% (n = 610) der Patientinnen eine Nachexzision benötigten. Nur 2,4% der Patientinnen (n = 89) hatten definitiv befallene Schnittränder. Befallene Schnittränder traten häufiger in Verbindung mit hormonrezeptorpositiver Erkrankung, lobulärem Subtyp, Carcinoma in situ oder lokal fortgeschrittenen Tumoren auf und weniger oft bei Patientinnen nach vorheriger neoadjuvanter Chemotherapie oder triple-negativem Mammakarzinom. Die Kaplan-Meier-Überlebenskurven zeigten deutliche Unterschiede und schlechtere Outcomes bei Patientinnen mit definitiver R1-Resektion. Dagegen ermittelte die multivariate Cox-Regressionsanalyse keinen statistisch signifikanten Unterschied im Gesamtüberleben basierend auf den Schnittrand-Status. Eine brusterhaltende Therapie (HR 0,66; 95%-KI 0,54–0,81) sowie HER2-Überexpression (HR 0.65; 95%-KI 0,48–0,89) waren mit einem besseren Überleben assoziiert.

Schlussfolgerung

Patientinnen, die sich in unserer Studie einer brusterhaltenden Operation unterzogen hatten, wiesen bessere Outcomes auf als Patientinnen nach einer Mastektomie. Obwohl der Schnittrand-Status keine signifikante Auswirkung auf das Gesamtüberleben hatte, werden große multizentrische Studien benötigt, um die prognostischen Auswirkungen von negativen Schnitträndern nach einer Brustkrebstherapie hinsichtlich verschiedener Tumorstadien, Tumor-Subtypen und lokalen bzw. systemischen Behandlungen zu evaluieren.

Keywords

breast cancer - margin - R1 resection - survival

Schlüsselwörter

Mammakarzinom - Schnittrand - R1-Resektion - Überleben


Publikationsverlauf

Eingereicht: 01. Mai 2024

Angenommen nach Revision: 24. Juli 2024

Artikel online veröffentlicht:
02. September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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