OncoTargets and Therapy (May 2018)

Predicting initial margin status in breast cancer patients during breast-conserving surgery

  • Pan Z,
  • Zhu L,
  • Li Q,
  • Lai J,
  • Peng J,
  • Su F,
  • Li S,
  • Chen K

Journal volume & issue
Vol. Volume 11
pp. 2627 – 2635

Abstract

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Zihao Pan,1,2,* Liling Zhu,1,2,* Qian Li,1,2,* Jianguo Lai,1,2 Jingwen Peng,3 Fengxi Su,1,2 Shunrong Li,1,2 Kai Chen1,2 1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 2Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 3Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China *These authors contributed equally to this work Background: We sought to develop and validate a model for prediction of initial margin status during breast-conserving surgery (BCS).Methods: We included eligible breast cancer patients receiving BCS in Sun Yat-sen Memorial Hospital from January 2003 to December 2014. All patients received intraoperative frozen-section analysis for initial margin assessment. We used univariate and multivariate logistic regression analyses to screen for predictors. A nomogram was developed in the training cohort (n=1,193) from the south branch of the hospital and externally validated in the validation cohort (n=499) from the north branch. We used the area under the receiver-operating characteristic curve and Hosmer–Lemeshow tests to assess the discrimination and accuracy of the nomogram.Results: The initial margin-positivity rates were 19.5% and 25.2% in the training and validation cohorts, respectively. Preoperative tumor size, preoperative lymph-node status, suspicion of multifocality, hormone-receptor status, and HER2 status were significantly associated with margin status. The model included these five variables. The discrimination and calibration of the model were considered acceptable in both cohorts.Conclusion: The nomogram can predict the likelihood of having positive initial margins during BCS and may be useful for clinical decision-making in the surgical treatment of breast cancer patients. Keywords: breast cancer, breast-conserving surgery, margins, nomogram 

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