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

• Main Authors: Pan Z, Zhu L, Li Q, Lai J, Peng J, Su F, Li S, Chen K
• Format: Article
• Language: English
• Published: Dove Medical Press 2018-05-01
• Series: OncoTargets and Therapy
• Subjects: breast cancer; breast-conserving surgery; margins; nomogram
• Online Access: https://www.dovepress.com/predicting-initial-margin-status-in-breast-cancer-patients-during-brea-peer-reviewed-article-OTT

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