Impact of the SSO-ASTRO Margin Guideline on Rates of Re-excision After Lumpectomy for Breast Cancer: A Meta-analysis
Impact of the SSO-ASTRO Margin Guideline on Rates of Re-excision After Lumpectomy for Breast Cancer: A Meta-analysis
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DOI：
10.1245/s10434-019-07247-5
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发表时间：
2019-05-01
影响因子：
3.7
通讯作者：
Landercasper, Jeffrey
中科院分区：
文献类型：
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作者：
Havel, Liska;Naik, Himani;Landercasper, Jeffrey
背景五分之一的浸润性乳腺癌患者接受初次乳房肿瘤切除术，随后接受再次切除或乳房切除术。根据肿瘤切除术边缘宽度，何时再次切除缺乏明确性，导致了如此高的再次手术率。我们试图确定外科肿瘤学会（SSO）和美国放射肿瘤学家学会（ASTRO）边缘指南对肿瘤切除术后再手术率的影响。该指南建议省略“肿瘤上无墨水”标本的常规再切除。进行了系统的文献综述。对于符合条件的研究，采用随机效应模型对SSO-ASTRO边缘指南发表前后乳房肿瘤切除术再切除率进行荟萃分析。研究异质性通过Cochran's Q检验进行测量。5项机构研究、1项基于人群的研究和1项国家登记研究符合入选要求。每项研究的样本量范围为237至26，102。研究间存在显著异质性（Q = 19.779; p=0.003）。指南发表前和指南发表后的合并再切除率分别为22%（置信区间[CI] 20-23）和14%（CI 12-15）。以指导前再切除率作为参考值，指导后再切除的相关比值比为0.65（CI 0.54-0.78; p
Background. One in five patients undergoing initial lumpectomy for invasive breast cancer subsequently undergoes re-excision or mastectomy. A lack of clarity of when to re-excise based on lumpectomy margin width contributes to this high rate of reoperation. We sought to determine the impact of the Society of Surgical Oncology (SSO) and American Society of Radiation Oncologist (ASTRO) margin guideline on reoperation rates after lumpectomy. The guideline recommended omission of routine re-excision in specimens with "no ink on tumor".Methods. A systematic literature review was performed. For eligible studies, a random-effects model was used for a meta-analysis of lumpectomy re-excision prevalence before and after publication of the SSO-ASTRO margin guideline. Study heterogeneity was measured by the Cochran's Q test.Results. Five institutional, one population-based, and one national registry study met inclusion requirements. Sample size per study ranged from 237 to 26,102. There was significant interstudy heterogeneity (Q = 19.779; p=0.003). Pooled re-excision prevalence was 22% (confidence interval [CI] 20-23) before and 14% (CI 12-15) after guideline publication. With the pre-guideline re-excision prevalence used as the reference value, the associated odds ratio for re-excision after the guideline was 0.65 (CI 0.54-0.78; p