Factors related to re-excision procedures following primary breast-conserving surgery for women with breast cancer in the U.S. Military Health System.

Autor: Eaglehouse YL; Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.; Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland., Georg MW; Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland., Jatoi I; Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas., Shriver CD; Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.; Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.; Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland., Zhu K; Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.; Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2020 Feb; Vol. 121 (2), pp. 200-209. Date of Electronic Publication: 2019 Nov 29.
DOI: 10.1002/jso.25788
Abstrakt: Background and Objectives: Re-excision surgery is undertaken to obtain clear margins after breast-conserving surgery (BCS) for localized breast cancer. This study examines patient and tumor characteristics related to re-excision surgery in the universal-access Military Health System (MHS).
Methods: Retrospective analysis of patients with pathologically confirmed stage I-III breast cancer between 1998 and 2014 in the Department of Defense Central Cancer Registry and MHS Data Repository-linked databases who received primary BCS. Multivariable stepwise logistic regression methods identified characteristics associated with re-excision surgery (lumpectomy and mastectomy) and conversion to mastectomy, given as adjusted odds ratios (AOR) and 95% confidence intervals (CIs).
Results: Of 7637 women receiving BCS, 26.3% had a re-excision and 9.9% converted to mastectomy. Tumor location, larger tumor size (≥4 cm), and regional lymph node involvement were associated with a greater likelihood of re-excision and mastectomy conversion. Pathology before BCS (AOR, 0.39; 95% CI, 0.35, 0.44 for re-excision) and neoadjuvant treatment (AOR, 0.50; 95% CI, 0.36, 0.69 for re-excision) were associated with a decreased likelihood of these outcomes. Additionally, age, tumor histology, and military-specific variables were associated with mastectomy conversion.
Conclusion: Comprehensive preoperative workup, including tumor pathology, may better inform surgical decision-making and reduce re-excision rates.
(© 2019 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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