The association of surgical margins and local recurrence in women with ductal carcinoma in situ treated with breast-conserving therapy: A meta-analysis Journal Article


Authors: Marinovich, M. L.; Azizi, L.; Macaskill, P.; Irwig, L.; Morrow, M.; Solin, L. J.; Houssami, N.
Article Title: The association of surgical margins and local recurrence in women with ductal carcinoma in situ treated with breast-conserving therapy: A meta-analysis
Abstract: Purpose: There is no consensus on adequate negative margins in breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS). We systematically reviewed the evidence on margins in BCS for DCIS. Methods: A study-level meta-analysis of local recurrence (LR), microscopic margin status and threshold distance for negative margins. LR proportion was modeled using random-effects logistic meta-regression (frequentist) and network meta-analysis (Bayesian) that allows for multiple margin distances per study, adjusting for follow-up time. Results: Based on 20 studies (LR: 865 of 7883), odds of LR were associated with margin status [logistic: odds ratio (OR) 0.53 for negative vs. positive/close (p < 0.001); network: OR 0.45 for negative vs. positive]. In logistic meta-regression, relative to >0 or 1 mm, ORs for 2 mm (0.51), 3 or 5 mm (0.42) and 10 mm (0.60) showed comparable significant reductions in the odds of LR. In the network analysis, ORs relative to positive margins for 2 (0.32), 3 (0.30) and 10 mm (0.32) showed similar reductions in the odds of LR that were greater than for >0 or 1 mm (0.45). There was weak evidence of lower odds at 2 mm compared with >0 or 1 mm [relative OR (ROR) 0.72, 95 % credible interval (CrI) 0.47–1.08], and no evidence of a difference between 2 and 10 mm (ROR 0.99, 95 % CrI 0.61–1.64). Adjustment for covariates, and analyses based only on studies using whole-breast radiotherapy, did not change the findings. Conclusion: Negative margins in BCS for DCIS reduce the odds of LR; however, minimum margin distances above 2 mm are not significantly associated with further reduced odds of LR in women receiving radiation. © 2016, Society of Surgical Oncology.
Keywords: cancer recurrence; multimodality cancer therapy; cancer patient; cancer radiotherapy; disease association; cancer hormone therapy; partial mastectomy; intraductal carcinoma; meta analysis; human; article
Journal Title: Annals of Surgical Oncology
Volume: 23
Issue: 12
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2016-11-01
Start Page: 3811
End Page: 3821
Language: English
DOI: 10.1245/s10434-016-5446-2
PROVIDER: scopus
PUBMED: 27527715
PMCID: PMC5160992
DOI/URL:
Notes: Article -- Export Date: 1 November 2016 -- Source: Scopus
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MSK Authors
  1. Monica Morrow
    455 Morrow