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Abstract
Introduction. Over recent decades, the success of neoadjuvant systemic therapy (NST) has enabled a growing number of breast cancer (BC) patients to undergo breast-conserving surgery (BCS). However, there are differing opinions regarding the minimum safe distance from the resection margin to the tumor bed for BCS following NST.
Aim. To evaluate the impact of the minimum distance from the tumor bed to the resection margin on the incidence of local recurrence in BC patients after NST.
Materials and Methods. The study included patients with unifocal invasive BC (cT1-3N0-3M0) who underwent sectoral or oncoplastic resections after NST. Based on a preplanned analysis, patients were stratified into three groups according to the distance from the tumor bed to the resection margin: ≤ 2, > 2 to < 10, and ≥10 mm, and also by biological subtype. The primary endpoint was 5-year ipsilateral breast tumor recurrence-free survival (IBTR-FS). Secondary endpoints included 5-year overall survival (OS) and 5-year event-free survival (EFS).
Results. Of 2,608 analyzed patients, 237 who met the inclusion criteria constituted the final cohort. The median follow-up was 60 months. The 5-year IBTR-FS was 86.3 % in the ≤2 mm group, 89.7 % in the > 2 to < 10 mm group, and 94.2 % in the ≥10 mm group. Stratified by biological subtype, 5-year IBTR-FS rates were 97.4 % for Luminal A, 87.3 % for Luminal B, 84.5 % for HER2+, and 82.5 % for triple-negative breast cancer (TNBC).
Conclusion. While interpretation is limited by the small cohort sizes, the findings indicate that reducing the extent of resection does not correlate with an increased incidence of local recurrence in BC patients after NST. However, the relative risk of local recurrence was higher in patients with the HER2+ subtype in the group with a margin ≤ 2 mm from the resection edge.
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