Although recent years have seen improvement in systemic therapies and radiotherapy, the surgical approach is still a keystone in oncologic treatment. In this study we investigated the association between surgical margin status and surgical approach with disease progression and death of breast cancer patients treated in the Oncology Sector of a Public Hospital of Minas Gerais.
Observational and retrospective study: A total of 1979 medical records of women with breast cancer treated in the period of 1981 to 2013 were analyzed. The surgical approach and surgical margin were obtained from anatomopathological reports. Of the total, 987 were excluded for lack of pathologic data, being diagnosed at stage IV or pathogical 0 stage.
Of the subtotal, 992 medical records reported the surgery approach (radical or breast-conserving), and 905 reported surgical margins, of which 110 had positive margin and 795 negative margin. The median age was of 55 y.o. (27-91). It was observed that 49.69% (n = 493) of surgeries were breast-conserving. No association between surgical approach and local relapse (p = 0.2672) was observed. However, increased odds of surgical margin impairment (OR = 1.531; p = 0.0395) and decreased odds of distant relapse (OR = 0.4068; p < 0.0001) and death (OR = 0.1455; p < 0.0001) was observed for breast-conserving surgeries compared with radical surgeries. No association between surgical margin and local relapse was observed (p = 0.1063). However, patients with positive surgical margin had greater odds of distant relapse (OR = 1.940; p = 0.0052) and death (OR = 2.002; p = 0.0494). When analyzed by pathological stage (I-III), it was observed that positive surgical margin increased the odds of distant relapse in stage II (OR = 2.280; p = 0.00499) and III (OR = 2.820; p = 0.0132) patients.
Although an association between radical surgery and death was observed, factors such as tumor complexity and locally advanced tumor could be involved. However, it is noteworthy that positive surgical margin increased the odds of distant relapse, mainly in stage III patients, and death. These data corroborate the fact that the surgical approach is still a keystone in breast cancer treatment and it has a strong impact in patients with locally advanced tumors.
Clinical trial identification
Legal entity responsible for the study
Grupo Luta Pela Vida.
Grupo Luta Pela Vida.
All authors have declared no conflicts of interest.