编者按：保乳治疗是早期乳腺癌的治疗标准。进入多模式治疗时代后，关于切缘不足补救手术意义的争论仍在继续，虽然指南已经更新，但是再切除率仍然居高不下。

2018年5月10日，美国乳腺外科医师学会和外科肿瘤学会《外科肿瘤学年鉴》在线发表加拿大马尼托巴大学、渥太华大学、马尼托巴癌症基金会的研究报告，探讨了肿瘤切除术后切缘不足的局部再切除率，以及再切除时残余病变的预测因素。

该人群回顾队列研究对马尼托巴（加拿大经济和人口排名第五大省）2009～2012年接受乳房肿瘤切除术切缘不足（≤2mm）或阳性而导致再切除的乳腺癌患者，通过省癌症登记数据库和病历复核，确定患者人口统计学和肿瘤学特征。对于浸润癌患者，报告六个解剖学切缘的切缘状态、宽度、切缘病理学类型。

结果发现，接受乳房肿瘤切除术患者共2494例，其中接受再切除术556例，再切除率为22.29%。浸润癌患者接受再切除术311例，再切除时发现残余病变占62.7%。

根据单因素分析，再切除时发现残余病变显著相关因素（P<0.05）包括：

• 浸润癌大小和分级

• 淋巴结分期

• 阳性切缘数量

根据多因素分析，除了淋巴结分期，其他因素仍然显著相关。

因此，该研究结果表明，除了肿瘤墨染，肿瘤切除标本分级和肿瘤大小也是残余病变的高风险因素，并且该亚组患者可能获益于再切除术。需要对该队列进行长期随访，以确定其辅助治疗后的复发风险。

Ann Surg Oncol. 2018 May 10. [Epub ahead of print]

Predictors of Residual Disease After Breast Conservation Surgery.

Lisa J. Findlay-Shirras, Oussama Outbih, Charlene N. Muzyka, Katie Galloway, Pamela C. Hebbard, Maged Nashed.

University of Manitoba, Winnipeg, Canada; University of Ottawa, Ottawa, Canada; CancerCare Manitoba, Winnipeg, Canada.

INTRODUCTION: Breast-conserving therapy is the standard of care for early-stage breast cancer. In the era of multimodality therapy, the debate on the value of revision surgery for compromised margins continues, and high re-excision rates persist despite updated guidelines. Our study sought to identify the local re-excision rate for compromised margins after lumpectomy, and identify predictors of residual disease at re-excision.

METHODS: This population-based retrospective cohort study included women with breast cancer who underwent a lumpectomy between 2009 and 2012 in Manitoba, with close (≤ 2 mm) or positive margins that led to re-excision. Patient demographics and tumor characteristics were identified through provincial cancer registries and chart reviews. For patients with invasive cancer, the six anatomical margins were reported for margin status, width, and pathology type at the margin.

RESULTS: Of the 2494 patients identified, 556 women underwent re-excision, yielding a re-excision rate of 22.29%. Of our 311 patients with invasive cancer who underwent re-excision, 62.7% had residual disease identified on revision. On univariable analysis, the size and grade of the invasive component, nodal stage, and the number of positive margins were associated with residual disease on re-excision (p < 0.05). With the exception of nodal stage, the same variables remained statistically significant on multivariable analysis.

CONCLUSIONS: Our results suggest that even in the absence of 'no ink on tumor', the cancer size and grade in lumpectomy specimens are high-risk factors for residual disease, and this subgroup of patients may benefit from re-excision. Long-term follow-up of this cohort is required to determine their risk of recurrence after adjuvant treatment.

DOI: 10.1245/s10434-018-6454-1