Recurrence and survival effect in breast conserving surgery: what are the predictive and/or prognostic factors?

Breast conserving surgery [BCS] is a widely accepted form of operation in patients with early breast cancer. Recurrence remains one of the greatest concerns in breast conserving surgery. It can provoke serious anxiety in the patient and, when treated by mastectomy, negate the objective of conservation. In this study we investigated the prognostic value of demographic, clinical and pathological factors and biological markers in breast cancer patients treated with BCS. This study was performed on 258 patients who underwent BCS from 2002 to 2010. All of the surgeries were performed by a single surgical team. Recurrence and its risk factors were evaluated. The mean age of the patients at the time of diagnosis was 50. The overall 10 year survival was 81%, 5 year survival was 88% and recurrence rate after surgery was 9%. Lymphovascular Invasion [LVI] was observed in 41 [16%] patients and in 11 [48%] patients with recurrence. Our study confirmed that tumors with estrogen receptor negative and LVI had more recurrence rate but other demographic, clinical and pathological factors and biological markers [progesterone receptor, P53, HER-2] did not have any significant effect on recurrence. We recommend considering LVI and estrogen receptor assay as a prognostic factor in the patients treated with BCS

Margin status influence on the outcome of patients treated with breast conserving surgery

Breast conserving surgery [BCS] followed by local radiotherapy is the standard treatment for early stage of breast cancer. Margin status may have an important impact on local recurrence and overall survival of patients treated with BCS, but this has not been defined adequately. In this study, we investigated the relationship between microscopic margins and outcome of BCS. Three hundred eighty four patients treated with BCS between 1999 and 2010 were included in our study. All surgeries were performed by a single surgical team. Margins were defined as close if surgical margins were less than 2 mm, as free if surgical margins were more than 2 mm and as positive if malignant cells were present in one of the tissue edges. Demographic, clinical, and pathological factors as well as biological markers, recurrence, and survival rates were compared between the close and the free margins groups. The mean age of patients at the time of diagnosis was 54.2 years. There were 34 [9%] recurrence cases and overall survival was 128.7 months and ten years survival rate was 81%. There was no significant difference between the close and the free margins groups in terms of demographic parameters, tumor characteristics, biological factors [estrogen and progesterone receptor status] and lymphovascular invasion. Also recurrence rate did not differ significantly between these two groups. Our study indicates that there is no significant difference between the patients with close and the free margins in terms of treatment results. There is no clear consensus in the surgeons' community over the definition of acceptable margin width in BCS, so additional studies are required to find the right answer