Ductal Carcinoma In Situ Size and Resection Volume Predict Margin Status
Ductal Carcinoma In Situ Size and Resection Volume Predict Margin Status
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DOI：
10.1097/coc.0b013e3181b9cf31
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发表时间：
2010-10-01
影响因子：
2.6
通讯作者：
Winchester, David J.
中科院分区：
文献类型：
--
作者：
Melstrom, Laleh G.;Melstrom, Kurt A.;Winchester, David J.
目的：有强有力的证据表明，导管原位癌（DCIS）切缘阴性的保乳手术（BCS）与低复发率相关。我们的目标是确定与 DCIS 的 BCS 阳性切缘相关的因素。方法：回顾性数据库审查确定了 823 名诊断为 DCIS 的患者。当前的分析包括 2000 年至 2006 年期间接受 BCS 治疗的 546 名患者，其中包含有关肿瘤和肿瘤切除尺寸的完整数据。分析的变量包括肿瘤大小、肿瘤切除体积、雌激素和孕激素受体状态、组织学亚型、分级和诊断时的年龄。使用chi(2) 分析和t 检验来确定可预测阳性切缘的因素。开发了多元回归模型来确定预测切缘阳性状态的自变量。结果：总共 33% 的标本具有阳性切缘。通过双变量分析，肿瘤切除体积、肿瘤大小、核分级（低与高）和 DCIS 阳性载玻片数量对于阳性切缘状态均具有重要意义。在多变量分析中，肿瘤大小（P < 0.001；比值比，2.37；95% 置信区间，1.712, 3.296）和切除体积（P = 0.0006；比值比，0.48；95% 置信区间，0.318, 0.729）仍然与阳性切缘状态显着相关。诊断时的年龄、组织学亚型、肿瘤分级以及雌激素和孕激素状态均与切缘状态无关。结论：DCIS BCS 后的阳性切缘与较大的病灶和较小的切除体积相关。 33% 的患者切缘阳性，这些数据表明，更积极的初始切除可能会避免切缘阳性，从而降低复发风险或额外手术的需要。
Objectives: There is strong evidence that breast conservation surgery (BCS) with negative margins for ductal carcinoma in situ (DCIS) is associated with low rates of recurrence. Our goal was to identify factors associated with positive margins in BCS for DCIS.Methods: A retrospective database review identified 823 patients diagnosed with DCIS. The current analysis included 546 of those patients treated with BCS from 2000 to 2006 with complete data regarding tumor and lumpectomy dimensions. Variables analyzed included tumor size, lumpectomy volume, estrogen and progesterone receptor status, histologic subtype, grade, and age at diagnosis. chi(2) analysis and t tests were used to identify factors that may predict positive margins. A multivariate regression model was developed to determine independent variables predictive of positive margin status.Results: A total of 33% of specimens had positive margins. Lumpectomy volume, tumor size, nuclear grade (low vs. high), and number of slides positive for DCIS were all significant for positive margin status by bivariate analysis. On multivariate analysis, tumor size (P < 0.001; odds ratio, 2.37; 95% confidence interval, 1.712, 3.296) and resection volume (P = 0.0006; odds ratio, 0.48; 95% confidence interval, 0.318, 0.729) remained significantly associated with positive margin status. Age at diagnosis, histologic subtype, tumor grade, and estrogen and progesterone status all were not associated with margin status.Conclusions: Positive margins after BCS for DCIS are associated with larger lesions and a smaller volume of resection. With 33% of patients having positive margins, these data suggest that a more aggressive initial resection may avoid positive margins and thus lower the risk of recurrence or the need for additional surgery.