Impact of the Society of Surgical Oncology-American Society for Radiation Oncology Margin Guidelines on Breast-Conserving Surgery and Mastectomy Trends
Impact of the Society of Surgical Oncology-American Society for Radiation Oncology Margin Guidelines on Breast-Conserving Surgery and Mastectomy Trends
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DOI：
10.1016/j.jamcollsurg.2019.02.051
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发表时间：
2019-07-01
影响因子：
5.2
通讯作者：
Yao, Katharine
中科院分区：
文献类型：
--
作者：
Kantor, Olga;Pesce, Catherine;Yao, Katharine
背景：2014年，外科肿瘤学会和美国放射肿瘤学会指南将I期和II期乳腺癌的阴性切缘定义为“无肿瘤”。我们假设，自指南引入以来，重复手术率有所下降，这可能与总体手术趋势的变化有关。研究设计：使用国家癌症数据库来识别2004年至2015年期间因I期和II期乳腺癌接受初始保乳手术（BCS）的女性。结果：在521,578例首次行BCS的患者中，82.7%的患者单独行BCS， 17.3%的患者重复手术：67%的患者行BCS后再行BCS， 24%的患者行BCS后单侧乳房切除术，9%的患者行BCS后双侧乳房切除术（BM）。重复手术率由2004年的16.2%下降到2015年的14.0% （p < 0.01）。保乳手术合并重复BCS从12.8%下降到9.7%，BCS合并BM从2004年的0.7%上升到2013年的1.9%，然后下降到2015年的1.4%。所有手术患者的趋势显示，2013年BCS率为64.0%，2015年上升至67.6%。BM率从2004年的4.6%上升到2013年的13.6%，2015年下降到12.8% （p < 0.05）。调整后的多变量回归发现，2014年之前被诊断为重复手术的独立预测因子（比值比[OR] 1.25）、年龄小于50岁（比值比[OR] 1.70）、Her2neu受体阳性肿瘤（比值比[OR] 1.61）和小叶组织学（比值比[OR] 1.61）。结论：2014年以后，重复手术率呈下降趋势，这也与BCS的上升和BM率的下降有关。早期乳腺癌切缘指南的传播可能会影响整体手术趋势。(C) 2019年由美国外科医师学会发布。Elsevier Inc.出版。版权所有。)
BACKGROUND: In 2014, the Society of Surgical Oncology and American Society for Radiation Oncology guidelines defined negative margin for stage I and II breast cancer as "no tumor on ink." We hypothesized that repeat operation rates have decreased since the guideline introduction and would be associated with changes in overall surgical trends.STUDY DESIGN: The National Cancer Database was used to identify women who underwent initial breast-conserving surgery (BCS) for stage I and II breast cancer from 2004 to 2015.RESULTS: Of 521,578 patients that underwent initial BCS, 82.7% had BCS alone and 17.3% had repeat operation: 67% with BCS followed by another BCS, 24% with BCS followed by unilateral mastectomy, and 9% with BCS followed by bilateral mastectomy (BM). The repeat operation rate decreased from 16.2% in 2004 to 14.0% in 2015 (p < 0.01). Breast-conserving surgery with repeat BCS decreased from 12.8% to 9.7%, and BCS followed by BM increased from 0.7% in 2004 to 1.9% 2013, then decreased to 1.4% in 2015. Trends for all surgical patients regardless of initial procedure showed a BCS rate of 64.0% in 2013 that increased to 67.6% in 2015. The BM rate increased from 4.6% in 2004 to 13.6% in 2013, then decreased to 12.8% in 2015 (p < 0.05). Adjusted multivariable regression found independent predictors of repeat operation to be diagnosis before 2014 (odds ratio [OR] 1.25), age younger than 50 years (OR 1.70), Her2neu receptor-positive tumors (OR 1.61), and lobular histology (OR 1.61).CONCLUSIONS: Repeat operation rates are decreasing after 2014, which is also associated with a rise in BCS and decrease in BM rates. Dissemination of margin guidelines for early-stage breast cancer might be impacting overall surgical trends. ((C) 2019 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.)