We are analyzing https://link.springer.com/article/10.1245/s10434-014-3480-5.

Title:
The Association of Surgical Margins and Local Recurrence in Women with Early-Stage Invasive Breast Cancer Treated with Breast-Conserving Therapy: A Meta-Analysis | Annals of Surgical Oncology
Description:
There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We systematically review the evidence on surgical margins in BCT for invasive breast cancer to support the development of clinical guidelines. Study-level meta-analysis of studies reporting local recurrence (LR) data relative to final microscopic margin status and the threshold distance for negative margins. LR proportion was modeled using random-effects logistic meta-regression. Based on 33 studies (LR in 1,506 of 28,162), the odds of LR were associated with margin status [model 1: odds ratio (OR) 1.96 for positive/close vs negative; model 2: OR 1.74 for close vs. negative, 2.44 for positive vs. negative; (P < 0.001 both models)] but not with margin distance [model 1: >0 mm vs. 1 mm (referent) vs. 2 mm vs. 5 mm (P = 0.12); and model 2: 1 mm (referent) vs. 2 mm vs. 5 mm (P = 0.90)], adjusting for study median follow-up time. There was little to no statistical evidence that the odds of LR decreased as the distance for declaring negative margins increased, adjusting for follow-up time [model 1: 1 mm (OR 1.0, referent), 2 mm (OR 0.95), 5 mm (OR 0.65), P = 0.21 for trend; and model 2: 1 mm (OR 1.0, referent), 2 mm (OR 0.91), 5 mm (OR 0.77), P = 0.58 for trend]. Adjustment for covariates, such as use of endocrine therapy or median-year of recruitment, did not change the findings. Meta-analysis confirms that negative margins reduce the odds of LR; however, increasing the distance for defining negative margins is not significantly associated with reduced odds of LR, allowing for follow-up time. Adoption of wider relative to narrower margin widths to declare negative margins is unlikely to have a substantial additional benefit for long-term local control in BCT.
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Keywords {🔍}

breast, margins, cancer, google, scholar, article, pubmed, margin, negative, therapy, distance, studies, breastconserving, oncol, status, model, odds, recurrence, local, surgery, followup, surgical, data, effect, cas, patients, adjusted, evidence, invasive, positive, study, models, median, association, time, covariates, subjects, analysis, metaanalysis, risk, included, treated, results, conservation, earlystage, close, radiation, stage, table, clin,

Topics {✒️}

random-effects logistic meta-regression high-dose-rate brachytherapy boost early-stage invasive cancer early-stage breast cancer margin-directed dose escalation early-stage invasive bc early-stage breast carcinoma nehmat houssami md t1-t2 breast cancer receive breast-conservation therapy examined pair-wise comparisons meta-analysis generally predated study-level meta-analysis nationwide population-based study evaluating prognostic studies—specifically long-term local control radiotherapy boost dose-escalation prospective margin-directed policy danish breast cancer prospective randomized trial japanese multi-institute survey luke marinovich early breast cancer study-specific median follow pair-wise comparisons lopez carrizosa mc 27-year single-institution experience study-specific median age medical research council random study effects surgical oncology aims breast cancer treated invasive breast cancer privacy choices/manage cookies natl cancer inst early breast carcinoma t2 breast cancer bmj publishing group samper ots pm eortc boost versus invasive breast carcinoma 1 high-power field van de velde breast cancer subtypes lymph node-negative avoid excessive resection van der palen breast cancer surgery her2-directed therapy aggregate tumour size

Questions {❓}

Margins in breast-conserving therapy: have we lost sight of the big picture?
Prognostic factors for local control after breast conservation: does margin status still matter?
What is an adequate margin for breast-conserving surgery?

Schema {🗺️}

WebPage:
      mainEntity:
         headline:The Association of Surgical Margins and Local Recurrence in Women with Early-Stage Invasive Breast Cancer Treated with Breast-Conserving Therapy: A Meta-Analysis
         description:There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We systematically review the evidence on surgical margins in BCT for invasive breast cancer to support the development of clinical guidelines. Study-level meta-analysis of studies reporting local recurrence (LR) data relative to final microscopic margin status and the threshold distance for negative margins. LR proportion was modeled using random-effects logistic meta-regression. Based on 33 studies (LR in 1,506 of 28,162), the odds of LR were associated with margin status [model 1: odds ratio (OR) 1.96 for positive/close vs negative; model 2: OR 1.74 for close vs. negative, 2.44 for positive vs. negative; (P < 0.001 both models)] but not with margin distance [model 1: >0 mm vs. 1 mm (referent) vs. 2 mm vs. 5 mm (P = 0.12); and model 2: 1 mm (referent) vs. 2 mm vs. 5 mm (P = 0.90)], adjusting for study median follow-up time. There was little to no statistical evidence that the odds of LR decreased as the distance for declaring negative margins increased, adjusting for follow-up time [model 1: 1 mm (OR 1.0, referent), 2 mm (OR 0.95), 5 mm (OR 0.65), P = 0.21 for trend; and model 2: 1 mm (OR 1.0, referent), 2 mm (OR 0.91), 5 mm (OR 0.77), P = 0.58 for trend]. Adjustment for covariates, such as use of endocrine therapy or median-year of recruitment, did not change the findings. Meta-analysis confirms that negative margins reduce the odds of LR; however, increasing the distance for defining negative margins is not significantly associated with reduced odds of LR, allowing for follow-up time. Adoption of wider relative to narrower margin widths to declare negative margins is unlikely to have a substantial additional benefit for long-term local control in BCT.
         datePublished:2014-01-29T00:00:00Z
         dateModified:2014-01-29T00:00:00Z
         pageStart:717
         pageEnd:730
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            Local Recurrence
            Adjusted Model
            Margin Status
            Negative Margin
            Surgical Oncology
            Oncology
            Surgery
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ScholarlyArticle:
      headline:The Association of Surgical Margins and Local Recurrence in Women with Early-Stage Invasive Breast Cancer Treated with Breast-Conserving Therapy: A Meta-Analysis
      description:There is no consensus on what constitutes adequate negative margins in breast-conserving therapy (BCT). We systematically review the evidence on surgical margins in BCT for invasive breast cancer to support the development of clinical guidelines. Study-level meta-analysis of studies reporting local recurrence (LR) data relative to final microscopic margin status and the threshold distance for negative margins. LR proportion was modeled using random-effects logistic meta-regression. Based on 33 studies (LR in 1,506 of 28,162), the odds of LR were associated with margin status [model 1: odds ratio (OR) 1.96 for positive/close vs negative; model 2: OR 1.74 for close vs. negative, 2.44 for positive vs. negative; (P < 0.001 both models)] but not with margin distance [model 1: >0 mm vs. 1 mm (referent) vs. 2 mm vs. 5 mm (P = 0.12); and model 2: 1 mm (referent) vs. 2 mm vs. 5 mm (P = 0.90)], adjusting for study median follow-up time. There was little to no statistical evidence that the odds of LR decreased as the distance for declaring negative margins increased, adjusting for follow-up time [model 1: 1 mm (OR 1.0, referent), 2 mm (OR 0.95), 5 mm (OR 0.65), P = 0.21 for trend; and model 2: 1 mm (OR 1.0, referent), 2 mm (OR 0.91), 5 mm (OR 0.77), P = 0.58 for trend]. Adjustment for covariates, such as use of endocrine therapy or median-year of recruitment, did not change the findings. Meta-analysis confirms that negative margins reduce the odds of LR; however, increasing the distance for defining negative margins is not significantly associated with reduced odds of LR, allowing for follow-up time. Adoption of wider relative to narrower margin widths to declare negative margins is unlikely to have a substantial additional benefit for long-term local control in BCT.
      datePublished:2014-01-29T00:00:00Z
      dateModified:2014-01-29T00:00:00Z
      pageStart:717
      pageEnd:730
      sameAs:https://doi.org/10.1245/s10434-014-3480-5
      keywords:
         Breast Cancer
         Local Recurrence
         Adjusted Model
         Margin Status
         Negative Margin
         Surgical Oncology
         Oncology
         Surgery
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         https://media.springernature.com/lw1200/springer-static/image/art%3A10.1245%2Fs10434-014-3480-5/MediaObjects/10434_2014_3480_Fig1_HTML.gif
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                     name:Screening and Test Evaluation Program (STEP), School of Public Health (A27), Sydney Medical School, University of Sydney, Sydney, Australia
                     type:PostalAddress
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            type:Person
            name:Monica Morrow
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                  name:Memorial Sloan Kettering Cancer Center
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                     name:Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
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Person:
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               name:Screening and Test Evaluation Program (STEP), School of Public Health (A27), Sydney Medical School, University of Sydney, Sydney, Australia
               type:PostalAddress
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      email:[email protected]
      name:Petra Macaskill
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            name:University of Sydney
            address:
               name:Screening and Test Evaluation Program (STEP), School of Public Health (A27), Sydney Medical School, University of Sydney, Sydney, Australia
               type:PostalAddress
            type:Organization
      name:M. Luke Marinovich
      affiliation:
            name:University of Sydney
            address:
               name:Screening and Test Evaluation Program (STEP), School of Public Health (A27), Sydney Medical School, University of Sydney, Sydney, Australia
               type:PostalAddress
            type:Organization
      name:Monica Morrow
      affiliation:
            name:Memorial Sloan Kettering Cancer Center
            address:
               name:Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
               type:PostalAddress
            type:Organization
PostalAddress:
      name:Screening and Test Evaluation Program (STEP), School of Public Health (A27), Sydney Medical School, University of Sydney, Sydney, Australia
      name:Screening and Test Evaluation Program (STEP), School of Public Health (A27), Sydney Medical School, University of Sydney, Sydney, Australia
      name:Screening and Test Evaluation Program (STEP), School of Public Health (A27), Sydney Medical School, University of Sydney, Sydney, Australia
      name:Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA

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