確定哪些患者的手術(shù)切緣陽性風(fēng)險(xiǎn)較高,，有助于提高臨床術(shù)前決策水平，并且降低再次手術(shù)率,。

　　2018年8月1日,，歐洲腫瘤外科學(xué)會《歐洲腫瘤外科雜志》在線發(fā)表中國臺灣彰化基督教醫(yī)院、臺北陽明大學(xué),、臺中中山醫(yī)學(xué)大學(xué),、臺北天主教耕莘醫(yī)院、臺中烏日林新醫(yī)院,、高雄醫(yī)學(xué)大學(xué)的研究報(bào)告,，對原發(fā)性可手術(shù)乳腺癌的手術(shù)切緣受累、再次手術(shù),、殘余癌相關(guān)臨床病理因素進(jìn)行了分析,。

　　該回顧研究分析了2050例接受保乳手術(shù)或乳房切除手術(shù)治療原發(fā)性可手術(shù)乳腺癌女性隊(duì)列的手術(shù)切緣陽性、再次切除需求,、再次切除標(biāo)本檢出殘余癌相關(guān)因素,。

　　結(jié)果發(fā)現(xiàn)，手術(shù)切緣陽性患者151例（7.4%）,。1042例保乳手術(shù)患者,、1008例乳房切除手術(shù)患者的手術(shù)切緣陽性發(fā)生率分別為11.3%、3.3%（P<0.001）,。

　　根據(jù)多因素分析,，保乳手術(shù)患者手術(shù)切緣陽性相關(guān)因素：患者體重指數(shù)較低、腫瘤較大,、病理學(xué)證實(shí)多灶病變,。再次手術(shù)風(fēng)險(xiǎn)較高相關(guān)因素：年齡較小、組織學(xué)亞型為乳腺導(dǎo)管原位癌（比值比：2.165，95%置信區(qū)間：1.253～4.323）,。

　　術(shù)前接受磁共振檢查的保乳手術(shù)患者：

• 切緣受累風(fēng)險(xiǎn)較低（比值比：0.530，95%置信區(qū)間：0.332～0.842）

• 再次手術(shù)風(fēng)險(xiǎn)較低（比值比：0.302,，95%置信區(qū)間：0.119～0.728）

　　組織學(xué)亞型為乳腺導(dǎo)管原位癌與其他類型乳腺癌相比,，殘余癌發(fā)生風(fēng)險(xiǎn)較高。

　　因此,，手術(shù)切緣陽性受累風(fēng)險(xiǎn)增加相關(guān)因素包括患者體重指數(shù)較低,、腫瘤較大、病理學(xué)證實(shí)多灶病變,、術(shù)前未接受磁共振檢查,，再次手術(shù)和再次切除檢出殘余癌風(fēng)險(xiǎn)增加相關(guān)因素為乳腺導(dǎo)管原位癌手術(shù)切緣陽性。

Eur J Surg Oncol. 2018 Aug 1. [Epub ahead of print]

Clinicopathologic factors related to surgical margin involvement, reoperation, and residual cancer in primary operable breast cancer- An analysis of 2050 patients.

Hung-Wen Lai, Ren-Hung Huang, Yu-Ting Wu, Chih-Jung Chen, Shou-Tung Chen, Ying-Jen Lin, Dar-Ren Chen, Chih-Wei Lee, Hwa-Koon Wu, Hui-Yu Lin, Shou-Jen Kuo.

Changhua Christian Hospital, Changhua, Taiwan; National Yang Ming University, Taipei, Taiwan; Chung Shan Medical University, Taichung, Taiwan; Cardinal Tien Hospital, Taipei, Taiwan; Wuri Lin Shin Hospital, Taichung, Taiwan; Kaohsiung Medical University, Kaohsiung, Taiwan.

BACKGROUND: To evaluate whether clinicopathologic factors are related to surgical margin involvement, reoperation, and residual cancer in primary operable breast cancer.

METHODS: Identification of patients at increased risk for positive surgical margins may enhance clinical preoperative decision-making and lower the reoperation rate. In this retrospective study, we analyzed the factors associated with positive surgical margins, the need for re-excision, and residual cancer detection in re-excised specimens in a cohort of 2050 women who underwent either breast-conserving surgery (BCS) or mastectomy for primary operable breast cancer.

RESULTS: Positive surgical margins were detected in 151 (7.4%) of the 2050 patients. The incidence of positive surgical margins was 11.3% (118/1042) in the BCS group and 3.3% (33/1008) in the mastectomy group (P<0.001). In multivariate analysis, lower body mass index (BMI), larger tumor size, and pathologic evidence of multifocal disease were associated with positive surgical margin involvement in the BCS group. Younger age and ductal carcinoma in situ (DCIS) histologic subtypes (Odds ratio(OR)=2.165, 95% CI=1.253～4.323) were associated with higher risk of re-operations. Preoperative MRI examination was associated with decreased risk for margin involvement in the BCS group (OR=0.530, 95% CI=0.332～0.842) and reoperation (OR=0.302, 95% CI=0.119～0.728). DCIS histologic subtypes were associated with higher residual tumor incidence than other types of breast cancer.

CONCLUSIONS: Lower BMI, larger tumor size, pathologic evidence of multifocal disease, and no preoperative MRI evaluation were associated with increased risk for positive surgical margin involvement. DCIS with positive surgical margins was associated with increased risk for reoperation and residual cancer detection at re-excision.

KEYWORDS: breast cancer, surgical margin, magnetic resonance imaging (MRI), breast-conserving surgery (BCS), mastectomy, ductal carcinoma in situ

DOI: 10.1016/j.ejso.2018.07.056