Abstract：
BACKGROUND: Questions have been raised as to an increased risk of local recurrence with breast-conserving surgery (BCS) post NAC highlighting the uncertainty around optimal margin width in this patient population. We examined the association between margin status and local recurrence-free survival (LRFS) in patients who underwent BCS following NAC.
METHODS: We performed a retrospective cohort study of adult female patients with stage I-III breast cancer who underwent NAC followed by BCS between 2012 and 2021 at two cancer centers. Margins were categorized as \"close\" if they were < 1 mm.
RESULTS: The full cohort included 544 patients with a median age of 53 years (interquartile range [IQR] 44-64). Pathologic complete response (pCR) was achieved in 41.2% of the overall cohort (n = 224). Of the 320 with residual disease, 29.4% (n = 94) had at least one close margin, and 10.9% (n = 35) had ≥2 close margins. Median follow-up was 55 months (IQR 32-83); 4.8% had an ipsilateral breast recurrence (n = 26). Patients with pCR had a higher 5-year LRFS than those with residual disease (98.0% vs. 91.6%, p = 0.02). There was no difference in 5-year LRFS between the margin categories (clear vs. 1 close margin vs. ≥2 close margins) in those with residual disease (92.2% vs. 88.9% vs. 92.9%) (p = 0.78).
CONCLUSIONS: In patients undergoing BCS post-NAC, those who achieved pCR had a significantly higher LRFS compared with those with residual disease at the time of surgery, but LRFS was not associated with margin width nor the number of close margins.
METHODS: We performed a retrospective cohort study of adult female patients with stage I-III breast cancer who underwent NAC followed by BCS between 2012 and 2021 at two cancer centers. Margins were categorized as \"close\" if they were < 1 mm.
RESULTS: The full cohort included 544 patients with a median age of 53 years (interquartile range [IQR] 44-64). Pathologic complete response (pCR) was achieved in 41.2% of the overall cohort (n = 224). Of the 320 with residual disease, 29.4% (n = 94) had at least one close margin, and 10.9% (n = 35) had ≥2 close margins. Median follow-up was 55 months (IQR 32-83); 4.8% had an ipsilateral breast recurrence (n = 26). Patients with pCR had a higher 5-year LRFS than those with residual disease (98.0% vs. 91.6%, p = 0.02). There was no difference in 5-year LRFS between the margin categories (clear vs. 1 close margin vs. ≥2 close margins) in those with residual disease (92.2% vs. 88.9% vs. 92.9%) (p = 0.78).
CONCLUSIONS: In patients undergoing BCS post-NAC, those who achieved pCR had a significantly higher LRFS compared with those with residual disease at the time of surgery, but LRFS was not associated with margin width nor the number of close margins.
摘要：
背景：关于NAC后保乳手术（BCS）局部复发风险增加的问题，突出了该患者群体中最佳边缘宽度的不确定性。我们检查了NAC后接受BCS的患者的边缘状态与无局部复发生存率（LRFS）之间的关系。
方法：我们在2012年至2021年期间在两个癌症中心进行了I-III期乳腺癌成年女性患者的回顾性队列研究，这些患者接受了NAC和BCS。如果边距<1mm，则将其分类为“关闭”。
结果：整个队列包括544例患者，中位年龄为53岁（四分位距[IQR]44-64）。病理完全缓解（pCR）在总队列的41.2％（n=224）中实现。在320名残留病患者中，29.4%(n=94)至少有一个收盘价，10.9%(n=35)的接近边缘≥2。中位随访时间为55个月（IQR32-83）；4.8%的患者患侧乳腺复发（n=26）。pCR患者的5年LRFS高于残留疾病患者(98.0%vs.91.6%,p=0.02)。保证金类别之间的5年期LRFS没有差异(明确与1接近保证金与≥2个闭合边缘)在有残留疾病的患者中(92.2%与88.9%vs.92.9%)(p=0.78)。
结论：在NAC后接受BCS的患者中，与手术时残留疾病的患者相比，达到pCR的患者的LRFS明显更高，但LRFS与边距宽度或接近边距的数量无关。
方法：我们在2012年至2021年期间在两个癌症中心进行了I-III期乳腺癌成年女性患者的回顾性队列研究，这些患者接受了NAC和BCS。如果边距<1mm，则将其分类为“关闭”。
结果：整个队列包括544例患者，中位年龄为53岁（四分位距[IQR]44-64）。病理完全缓解（pCR）在总队列的41.2％（n=224）中实现。在320名残留病患者中，29.4%(n=94)至少有一个收盘价，10.9%(n=35)的接近边缘≥2。中位随访时间为55个月（IQR32-83）；4.8%的患者患侧乳腺复发（n=26）。pCR患者的5年LRFS高于残留疾病患者(98.0%vs.91.6%,p=0.02)。保证金类别之间的5年期LRFS没有差异(明确与1接近保证金与≥2个闭合边缘)在有残留疾病的患者中(92.2%与88.9%vs.92.9%)(p=0.78)。
结论：在NAC后接受BCS的患者中，与手术时残留疾病的患者相比，达到pCR的患者的LRFS明显更高，但LRFS与边距宽度或接近边距的数量无关。
