Oestrogen receptor status predicts for local recurrence following wide local excision for breast tumours
© Lee et al. 2011
Published: 16 November 2011
Status of the surgical margins following wide local excision for breast cancer remains one of the strongest predictors of local recurrence. In our practice, a margin of 1 mm and more is considered adequate. In this study, we aim to determine whether clinicopathological factors other than surgical margins contribute to the risk of local recurrence.
A retrospective review was performed of 548 consecutive patients who underwent wide local excision for invasive carcinoma or ductal carcinoma in situ (DCIS) from 1 January 2004 to 31 December 2008. Surgery was not routinely offered to patients with margins of 1 mm or more. All patients with wide local excision received postoperative whole breast irradiation, inclusive of a boost to the tumour bed.
Local recurrence developed in 20% of those with involved margins, as compared with 8.7% of those with close margins, and 5.4% of those with margins of 1 mm and more. Although local recurrence was more likely with an involved or close surgical margin, this reached only borderline significance (P = 0.05). Oestrogen receptor (ER) status was found to be an independent predictor of local recurrence, with ER-negative tumours being three times more likely to recur (P < 0.01, OR = 0.30, 95% CI = 0.13 to 0.66). There was no correlation with a triple-negative phenotype or other clinicopathological factors.
A margin of 1 mm or more appears to be adequate following wide local excision. However, ER status emerged as a stronger predictor for local recurrence and alone remained significant on multivariate analysis.