Positive Margins In Patients Research Articles

399 Cancer Recurrence in Positive Margin Partial Nephrectomies: 5-Year Results from the West of Scotland

Abstract Aim Provide insight into the incidence of disease recurrence following a positive margin partial nephrectomy in Renal cancer patients. Allowing the analysis of the current surveillance protocols for early detection of disease recurrence. Method A retrospective review of all patients undergoing Partial Nephrectomies (PN) within a single centre between 2016 and 2021 was performed. Demographic data including age and sex, as well as tumour-specific data of histology, RENAL score, tumour margin, surveillance, and disease recurrence was recorded. Follow-up was performed as per WOSCAN guidance. Results 255 patients underwent PN: 79 (31%) open (OPN) and 176 (69%) robotic-assisted procedures (RALPN). OPN was performed in higher risk cancers with a higher risk of positive margin compared to RALPN (10.1% vs 6.25%). The median follow-up time was 35 months. 3 patients with positive margins had recurrence; all were pT3 cancer following OPN of which 2 had metastatic and 1 patient had local recurrence. 18 positive margin patients (95%) were compliant with WOSCAN surveillance guidelines. Conclusions OPN was performed for more complex tumours which had a higher risk of positive margins and thus recurrence. Regional data can be used to better counsel patients, however further work should assess any evolving change in RALPN positive margin rates as more complex tumours are attempted robotically.

A Systematic Review and Meta-Analysis of Mapping Biopsy for Primary Extramammary Paget's Disease in Reducing Recurrence Following Surgical Excision.

To examine the association between the performance of mapping biopsies and surgical outcomes postexcision of extramammary Paget's disease (EMPD). Primary EMPD is a rare entity associated with poorly defined surgical margins and difficult-to-access sites of lesions. Surgical resection with clear margins remains the preferred management method. The use of mapping biopsies might be beneficial, particularly in lowering disease recurrence. Available literature was reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology before a fixed-effect meta-analysis was performed to identify the presence of a correlation between performing mapping biopsies and positive margins on permanent sections as well as disease-free survival. Additional study results not included in the quantitative assessment were qualitatively assessed and reported. A total of 12 studies were shortlisted for final analysis. 294 patients who underwent mapping biopsies and 48 patients who did not undergo mapping biopsies were included in the assessment. Forest plot analysis revealed a pooled rate ratio of 0.50 (95% CI, 0.32-0.77) in the prevalence of positive margins in patients with mapping biopsies performed as compared to patients without. The pooled rate ratio of the prevalence of disease-free survival in patients with mapping biopsies performed as compared to patients without was 1.38 (95% CI, 1.03-1.84). Qualitative assessment of the remaining selected studies revealed equivocal results. Mapping biopsies are able to improve EMPD surgical excision outcomes but given the rarity of the disease and heterogeneity of mapping biopsy procedures, further confirmation with randomized controlled trials or a larger patient pool is necessary.

Variations in the definition and perceived importance of positive resection margins in patients with colorectal cancer – an EYSAC international survey

IntroductionMicroscopically positive resection margins (R1) are associated with poorer outcomes in patients with colorectal cancer. However, different definitions of R1 margins exist. It is unclear to what extent the definitions used in everyday clinical practice differ within and between nations. This study sought to investigate variations in the definition of R1 margins in colorectal cancer and the importance of margin status in clinical decision-making. Materials and methodsA 14-point survey was developed by members of The European Society of Surgical Oncology (ESSO) Youngs Surgeons and Alumni Club (EYSAC) Research Academy targeting all members of the multidisciplinary team (MDT) treating patients with colorectal cancer. The survey was distributed on social media, in ESSO's monthly newsletter and via national societies. ResultsIn total, 137 responses were received. Most respondents were from Europe (89.7%), with the majority from Denmark (56.9%). Less than 2/3 of respondents defined R1 margins as the presence of viable cancer cells ≤1 mm of the margin. Only 60% reported that subdivisions of R1 margins (primary tumour vs tumour deposit vs metastatic lymph node) are routinely available. More than 20% of respondents reported that pathology reports are not routinely reviewed at MDT meetings. Less than half of respondents considered margin status in decision-making for type and duration of adjuvant chemotherapy in Stage III colon cancer. ConclusionThe definitions and perceived clinical importance of microscopically positive margins in patients with colorectal cancer appear to vary. Adoption of an international dataset for pathology reporting may help to standardise current practices.

Positive surgical margins after breast-conserving surgery for ductal carcinoma in-situ: does histologic grade or estrogen receptor status matter?

DCIS has been shown to have a higher rate of positive margins following breast-conserving surgery (BCS) than invasive breast cancer. We aim to analyze certain factors of DCIS, specifically histologic grade and estrogen receptor (ER) status, in patients with positive surgical margins following BCS to determine if there is an association. A retrospective review of our institutional patient registry was performed to identify women with DCIS and microinvasive DCIS who underwent BCS by a single surgeon from 1999 to 2021. Demographics and clinicopathologic characteristics between patients with and without positive surgical margins were compared using chi-square or Student's t-test. We assessed factors associated with positive margins using univariate and multivariable logistic regression. Of the 615 patients evaluated, there was no significant difference in demographics between the patients with and without positive surgical margins. Increasing tumor size was an independent risk factor for margin positivity (P = < 0.001). On univariate analysis both high histologic grade (P = 0.009) and negative ER status (P = < 0.001) were significantly associated with positive surgical margins. However, when adjusted in multivariable analysis, only negative ER status remained significantly associated with margin positivity (OR = 0.39 [95% CI 0.20-0.77]; P = 0.006). The study confirms increased tumor size as a risk factor for positive surgical margins. We also demonstrated that ER negative DCIS was independently associated with a higher rate of positive margins after BCS. Given this information, we can modify our surgical approach to reduce rate of positive margins in patients with large-sized ER negative DCIS.

Development of machine learning models for the prediction of positive surgical margins in transoral robotic surgery (TORS).

To develop machine learning (ML) models for predicting positive margins in patients undergoing transoral robotic surgery (TORS). Data from 453 patients with laryngeal, hypopharyngeal, and oropharyngeal squamous cell carcinoma were retrospectively collected at a tertiary referral center to train (n=316) and validate (n=137) six two-class supervised ML models employing 14 variables available pre-operatively. The accuracy of the six ML models ranged between 0.67 and 0.75, while the measured AUC between 0.68 and 0.75. The ML algorithms showed high specificity (range: 0.75-0.89) and low sensitivity (range: 0.26-0.64) in detecting patients with positive margins after TORS. NPV was higher (range: 0.73-0.83) compared to PPV (range: 0.45-0.63). T classification and tumor site were the most important predictors of positive surgical margins. ML algorithms can identify patients with low risk of positive margins and therefore amenable to TORS.

Esophagectomy vs Gastrectomy for Early Stage Adenocarcinoma of the Gastroesophageal Junction: What is the Optimal Oncologic Surgical Treatment?

Guidelines for the management of gastroesophageal junction (GEJ) adenocarcinoma recommend esophagectomy as the preferred surgical treatment. Gastrectomy has been proposed as an equivalent procedure. This study aims to compare the oncologic outcomes of these operations. The National Cancer Database was queried for patients with clinical T1N0M0 (all sizes) and T2N0M0 (≤2cm) GEJ adenocarcinoma from 2004-2017. Patients treated with surgery-only were included and were stratified by surgical treatment. Propensity-score matching (PSM) was used to create a balanced cohort. Multivariable logistic regression was performed to evaluate for factors predictive of treatment. Kaplan-Meier (KM) and Cox proportional hazards models were used to compare overall survival (OS). 2,446 patients were identified. 75.1% received esophagectomy, while 24.9% were treated with gastrectomy. Patients at high volume facilities were more likely to undergo esophagectomy (OR 1.750, P < 0.001). Factors associated with lower likelihood of undergoing esophagectomy included age ≥75 years (OR 0.588, P = 0.001), female sex (OR 0.706, P = 0.003), and non-White race (OR 0.430, P < 0.001), compared to age ≤50 years, male, and White race, respectively. In the unmatched cohort, gastrectomy was associated with a higher rate of positive margins (4.1% vs 2.3%, P = 0.022). PSM yielded 591 pairs. In the matched cohort, patients treated with esophagectomy had improved 5-year OS compared to gastrectomy (70.6% vs 66.5%, P = 0.030). Multivariable analysis showed improved OS in patients treated with esophagectomy compared to gastrectomy (HR 0.767, P = 0.010). Esophagectomy is associatedwith improved survival and a lower incidence of positive margins in patients with early-stage GEJ adenocarcinoma when compared to gastrectomy.

Development and Validation of a Prediction Model for Positive Margins in Breast-Conserving Surgery.

BackgroundThe chances of second surgery due to positive margins in patients receiving breast-conversing surgery (BCS) were about 20-40%. This study aims to develop and validate a nomogram to predict the status of breast-conserving margins.MethodsThe database identified patients with core needle biopsy-proven ductal carcinoma in situ (DCIS) or invasive breast carcinoma who underwent BCS in Shanxi Bethune Hospital between January 1, 2015 and December 31, 2021 (n = 573). The patients were divided into two models: (1) The first model consists of 398 patients who underwent BCS between 2015 and 2019; (2) The validation model consists of 175 patients who underwent BCS between 2020 and 2021. The development of the nomogram was based on the findings of multivariate logistic regression analysis. Discrimination was assessed by computing the C-index. The Hosmer-Lemeshow goodness-of-fit test was used to validate the calibration performance.ResultsThe final multivariate regression model was developed as a nomogram, including blood flow signals (OR = 2.88, p = 0.001), grade (OR = 2.46, p = 0.002), microcalcifications (OR = 2.39, p = 0.003), tumor size in ultrasound (OR = 2.12, p = 0.011) and cerbB-2 status (OR = 1.99, p = 0.042). C-indices were calculated of 0.71 (95% CI: 0.64-0.78) and 0.68 (95% CI: 0.59-0.78) for the modeling and the validation group, respectively. The calibration of the model was considered adequate in the validation group (p > 0.05).ConclusionWe developed a nomogram that enables the estimation of the preoperative risk of positive BCS margins. Our nomogram provides a valuable tool for identifying high-risk patients who might have to undergo a wider excision.

Adjuvant Chemotherapy Might Be Recommended to Patients With Positive Margin After Gastrectomy: A 20-Year Retrospective Analysis in a Single Center.

BackgroundMargin positivity after gastric cancer resection is associated with poorer outcomes. However, the prognostic factors and the choice of postoperative adjuvant treatment of patients with positive margin (PM) after gastrectomy are still being debated.MethodsA single-center, retrospective analysis was conducted for patients with PM after gastrectomy from the China National Cancer Center Gastric Cancer Database (NCCGCDB) from 1998 to 2018. Univariate and multivariate Cox regression analyses were performed to identify prognostic factors of overall survival (OS) and recurrence-free survival (RFS).ResultsA total of 449 patients were included in the study, including 192 (42.8%) in the proximal PM group (PPM), 205 (45.7%) in the distal PM group (DPM), and 52 (11.6%) in the bilateral PM group (BPM). The 3- and 5-year OS rates for the PM patients investigated were 47.5% and 39.3%, respectively, and the 3- and 5-year RFS rates were 60.0% and 53.6%, respectively. Multivariate Cox regression analysis proved total gastrectomy (hazard ratio (HR): 1.783, 95%CI: 1.133–2.805, p = 0.012), pT4 (HR: 5.264, 95%CI: 1.493–18.565, p = 0.01), pN2 (HR: 2.263, 95%CI: 1.164–4.397, p = 0.016), pN3 (HR: 2.327, 95%CI: 1.233–4.393, p = 0.009), and combined resection (HR: 1.952, 95%CI: 1.256–3.034, p = 0.003) to be independent risk factors of OS, and pT3 (HR: 9.257, 95%CI: 1.152–74.386, p = 0.036) and pT4 (HR: 11.361, 95%CI: 1.469–87.847, p = 0.020) to be independent risk factors for RFS. Adjuvant chemotherapy prolonged OS in the PPM group (p = 0.032) and prolonged RFS in the PPM group (p < 0.001) and the DPM group (p = 0.035) compared with surgery alone.ConclusionsAdvanced pathologic stage was associated with poor prognosis, and postoperative adjuvant chemotherapy might be recommended in PM patients after gastrectomy. Still, further prospective trials are warranted to verify and support our conclusions.

PE09 - Impact of Intraoperative Frozen Section (NeuroSAFE) during robotic radical prostatectomy on rates of nerve-sparing and positive margins in patients with preoperative mpMRI and PSMA PET/CT: Initial experience

PE09 - Impact of Intraoperative Frozen Section (NeuroSAFE) during robotic radical prostatectomy on rates of nerve-sparing and positive margins in patients with preoperative mpMRI and PSMA PET/CT: Initial experience

The impact of positive margin on survival in oral cavity squamous cell carcinoma

BackgroundPositive margins are known to impact survival in oral cavity squamous cell carcinoma (OCSCC). We aimed to determine the impact of positive margins on survival and whether radiation improves survival following positive margins. MethodsData was obtained from the National Cancer Database and included patients with cT1T2N0 OCSCC.Survival outcomes were assessed via log-rank test. Cox-regression analysis was performed to determine if positive margins or radiation, when applicable, correlated with survival after accounting for covariates. ResultsPositive margin patients had worse overall survival compared to negative margin control (HR = 1.76, p < 0.001) and reduced survival by 13%. On multivariate analysis, positive margins correlated with survival (HR = 1.60, p < 0.001). Radiation did not improve survival in positive margin patients (HR = 0.99, p = 0.55). ConclusionsPatients with positive margins have an 11–15% worse overall survival. Radiation does not appear to impact survival in patients with a positive margin.

Association of menopause, aging and treatment procedures with positive margins after therapeutic cervical conization for CIN 3: a retrospective study of 8,856 patients by the Japan Society of Obstetrics and Gynecology.

ObjectiveThe Japan Society of Obstetrics and Gynecology conducted a retrospective multi-institutional survey of patients who underwent cervical conization in Japan. This study aimed to determine the predictive factors for positive surgical margins in cervical intraepithelial neoplasia grade 3 (CIN 3) patients after therapeutic cervical conization and those for positive margins in patients who did not experience recurrence and did not undergo additional treatment.MethodsIn 2009 and 2013, 14,832 patients underwent cervical conization at 205 institutions in Japan. Of these, 8856 patients who underwent therapeutic conization fulfilled the inclusion criteria. Their histologic findings and clinical outcomes were evaluated based on standard statistical procedures and clinical and demographic characteristics.ResultsNegative and positive margins were observed in 7,585 and 1,271 (14.4%) patients, respectively. The predictors of positive margins were menopausal status (p<0.001), loop electrosurgical excision procedure (p<0.001), and Shimodaira-Taniguchi (S-T) conization (p<0.001). Of 1,271 patients with positive margins, 1,060 underwent no additional treatment; among those 1,060 patients, 129 (12.2%) experienced recurrence. The predictors of positive margins in patients who did not undergo additional treatment and did not experience recurrence were age, parity, gravidity, S-T conization, and laser scalpel conization.ConclusionMenopausal status and treatment procedures were associated with positive margins after therapeutic conization of CIN 3. It is important to understand the characteristics of treatment procedures and select an appropriate procedure for each case. For elderly or menopausal patients with positive margins, immediate additional treatment is recommended.

Resection Margin Status and Radiation Boost to Surgical Cavity after Breast Conserving Surgery, a Pattern-of-Practice Study in British Columbia, Canada

The 2014 Society of Surgical Oncology-American Society for Radiation Oncology (SSO-ASTRO) guideline defines ‘no tumor on ink’ as the adequate margin after breast conserving surgery (BCS). This study evaluates resection margin status and the use of surgical cavity boost following whole-breast radiation (WBRT) in British Columbia before and after the guideline publication. Using Breast Cancer Outcome Unit (BCOU) database, we identified 8,186 patients referred to BC Cancer with pT1-T3, any N, M0 invasive carcinoma diagnosed between 2010 and 2016. Patients were treated with BCS followed by WBRT with or without boost. Logistic regression was used to model the determinants of boost delivery. Fine and Gray competing risk analysis, with death and distant relapse as competing events, was used to assess the impact of boost on local control. The median follow-up was 5.6 years. The proportion of close (<2mm) or positive margin status was 25.5% in 2010-2014 and 25.9% in 2015-2106 (p = 0.66). Boost was used in 24.8% in margin-negative and 74.8% in close- or positive-margin patients. Boost utilization was 37.9% in 2010-2014 and 36.9% in 2015-2016 (p = 0.37). On multivariable analysis, younger age (OR 1.08, 95% CI = 1.07-1.08, p<0.0001), grade 3 (OR 1.34, 95%CI = 1.12-1.60, p = 0.0009), and positive or close margins (OR 12.6, CI = 11.1-14.4, p<0.0001) were significantly associated with boost delivery. Diagnosis in 2010-2014 compared to 2015-2016 was not associated with boost receipt (OR 1.05, 95%CI = 0.93-1.19, p = 0.46). On competing risk analysis, after adjusting for margin status, age, stage, grade, endocrine and HER2 status, boost was not associated with local control (HR 0.89, 95%CI = 0.56-1.43, p = 0.64). This study did not demonstrate a change in the likelihood of a close- or positive-margin status or boost utilization after the publication of the SSO-ASTRO consensus. For patients treated from 2010-2016, boost receipt was not associated with improved local control.

Effect of Intraoperative Imprint Cytology Followed by Frozen Section on Margin Assessment in Breast-Conserving Surgery.

Intraoperative margin assessment can reduce positive margins in patients undergoing breast-conserving surgery. However, reports on intraoperative margin assessment have described only the use of either imprint cytology or frozen section. This study was designed to elucidate the effect of intraoperative margin assessment using imprint cytology followed by frozen section. Overall, 522 patients were enrolled. First, the entire surgical margin was subjected to imprint cytology. Frozen section was performed only in cases with "positive" or "suspicious" imprint cytology results. An additional intraoperative excision was performed in patients with frozen section-positive lesion sites. All margins were evaluated using postoperative permanent sections after excision. Among 522 patients, 136 (26.1%) were imprint cytology-positive, and 386 (73.9%) were imprint cytology-negative. Among the 386 imprint cytology-negative patients not subjected to frozen section, 11 (2.1%) were permanent sections-positive (imprint cytology-false-negative). In 47 of the 136 imprint cytology-positive patients, additional intraoperative excision was unnecessary due to the frozen section-negative diagnosis. Moreover, these patients could avoid reoperation, because they were permanent section-negative. The false-positive rate of imprint cytology alone was 13.4%, but adding frozen section to imprint cytology decreased the overall false-positive rate to 2.5%. After undergoing excision, four patients still had positive margins. The overall positive margin rate in the final pathology based on permanent sections was 2.9% (15/522). Imprint cytology followed by frozen section led to a markedly decreased positive margin rate. This is considered the best method for intraoperative margin assessment, as it can overcome the limitations of cytology and histology performed individually.

MP19-17 TUMOR ZONALITY ON PREOPERATIVE MRI IS AN INDEPENDENT PREDICTOR FOR POSITIVE SURGICAL MARGIN AFTER RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP19)1 Apr 2020MP19-17 TUMOR ZONALITY ON PREOPERATIVE MRI IS AN INDEPENDENT PREDICTOR FOR POSITIVE SURGICAL MARGIN AFTER RETZIUS-SPARING ROBOT-ASSISTED RADICAL PROSTATECTOMY Youjian Li*, Xuefeng Qiu, and Hongqian Guo Youjian Li*Youjian Li* More articles by this author , Xuefeng QiuXuefeng Qiu More articles by this author , and Hongqian GuoHongqian Guo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000852.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To investigate the influence of tumor zonality on positive surgical margin (PSM) after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). METHODS: Consecutive 203 patients with prostate cancer (PCa) who underwent RS-RARP in our center were divided into three cohorts according to the tumor zonal origin described on preoperative magnetic resonance imaging (MRI). Clinical and pathological characteristics outcomes were compared between the groups. Relationship of various tumor clinicopathological parameters to PSM after RS-RARP were evaluated. RESULTS: The rates of PSM in men with transition zone and mixed tumors were significantly higher than those with peripheral zone tumors (p = 0.001). 42.0% and 40.9% of the positive margins in patients with transition zone and mixed cancers were located at the anterior part of the gland, respectively. On multivariate analysis, transition zone tumor was significantly associated with higher PSM rates after RS-RARP (p = 0.007). Sub-analysis revealed that transition tumor in patients with high-risk cases had a higher risk of PSM after RS-RARP (p= 0.003). CONCLUSIONS: Transition zone tumor is an independent risk factor for PSM after RS-RARP. Preoperative identification of transition zone tumor might aid surgical planning with Retzius-sparing technique, especially for patients with high-risk PCa. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e304-e304 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Youjian Li* More articles by this author Xuefeng Qiu More articles by this author Hongqian Guo More articles by this author Expand All Advertisement PDF downloadLoading ...

Risk factors associated with positive resection margins in patients with adrenocortical carcinoma

BackgroundPositive resection margins are associated with worse survival after surgery for adrenocortical carcinoma (ACC). We aimed to identify risk factors for positive margins post-resection. MethodsThe NCDB was queried for ACC patients from 2006 to 2015. Patients with positive versus negative resection margins post-surgery were compared using Chi-square tests. Survival based on adjuvant treatment was assessed using Kaplan-Meier curves. Results1,973 patients with ACC were identified, 217 (11.0%) with positive margins. Multivariable analysis identified extra-adrenal extension (HR 4.92, p < 0.001), lymph node metastases (HR 2.64, p = 0.001), and distant metastases (HR 1.53, p = 0.03) as risk factors for positive margins. No significant difference in margin status existed between patients who had an open versus minimally invasive procedure (p = 0.6). Positive margin patients receiving adjuvant radiation (p = 0.007) or combined chemo-radiation (p = 0.001) had the longest survival. ConclusionNo modifiable risk factors were identified, but patients with positive margins receiving adjuvant radiation or chemo-radiation had the longest survival.

Efficacy of intraoperative specimen radiography as margin assessment tool in breast conserving surgery.

To explore the ability of intraoperative specimen radiography (SR) to correctly identify positive margins in patients receiving breast conserving surgery (BCS). To assess whether the reoperation rate can be reduced by using this method. This retrospective study included 470 consecutive cases receiving BCS due to a primarily diagnosed breast cancer. SR was carried out in two planes, assessing the specimen regarding the presence of the lesion and its relation to all margins. If indicated, re-excision of selective orientations was advised. Under consideration of gross inspection and the SR-findings, it was up to the surgeon whether to perform re-resections. The recommendations for re-excision were, separately for each orientation, compared to the histopathological results, serving as gold standard. Intraoperative SR was performed in 470 cases, thus 2820 margins were assessed. Of those, 2510 (89.0%) were negative and 310 (11.0%) positive. SR identified 2179 (77.3%) margins correctly as negative, whereas 331 (11.7%) clear margins were misjudged as positive. Of 310 infiltrated margins, SR identified 114 (4.0%) correctly, whereas 196 (7.0%) infiltrated margins were missed. This resulted in a sensitivity/specificity of 36.8%/86.8% and PPV/NPV of 25.6%/91.8%. Through targeted re-resections positive margins could be reduced by 31.0% [310 to 214 (7.6%)]. On case level, the rate of secondary procedures could be reduced by 37.0% [from 162 to 102 (21.7%)]. SR is a helpful tool to identify infiltrated margins and to reduce the rate of secondary surgeries by recommending targeted re-excisions of according orientations in order to obtain a final negative margin status.

Obesity is a predictor in prostate cancer patients receiving prostatectomy after neoadjuvant hormonal therapy.

This study aimed to investigate the relationship between obesity and pathologic features and biochemical recurrence in patients with prostate cancer (PCa) undergoing radical prostatectomy (RP) after neoadjuvant hormonal therapy (NHT). A total of 422 consecutive patients with clinically localized PCa who received NHT before RP were retrospectively analyzed. Unconditional multiple logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) regarding probability. A receiver operating characteristic (ROC) curve was used to assess the efficacy of the predictive variables. Castration resistance free survival curves were obtained using the Kaplan-Meier method, and were compared using the log-rank test. Being overweight was associated with an increased risk of positive margins (OR 2.281; 95% CI 1.292-4.028) after adjusting for potential confounders. The area under the ROC curve for overweight patients was larger than that for patients in the normal weight range. There was no significant difference between the overweight and normal weight groups regarding castration resistance free survival. Being overweight was associated with positive margins in patients with PCa undergoing RP after NHT.

Preoperative biopsy in parotid malignancies: Variation in use and impact on surgical margins.

Determine rate of preoperative biopsy in parotid malignancies, identify factors associated with its use, and its association with surgical margins. Retrospective cohort. Commission on Cancer-Accredited Institutions. We included 5533 patients treated surgically for a parotid malignancy 2004-2014 in the National Cancer Database. Chi-squared tests, univariable, and multivariable logistic regressions were used to evaluate predictors of preoperative biopsy (defined as needle, aspiration, or incisional), and associate biopsy with surgical margins. Preoperative biopsy was utilized in 26.0% of patients. Biopsy was more likely in patients >60 years (odds ratio [OR]: 1.19, P = .035), advanced clinical T stage (vs. T1,T2 OR: 1.23, P = .009; T3 OR: 1.26, P = .026; T4A OR: 2.05, P < .001), advanced clinical N stage (vs. N0, N1: OR: 1.39, P = .013; N2/3: OR: 1.63, P < .001), in academic centers (OR: 1.18, P < .024), and in higher volume centers (vs. low, medium OR: 1.28, P = .002; high OR: 2.16, P < .001). Biopsy use increased over time (vs. 2004-2006, 2007-2010 OR: 1.20, P = .047; 2011-2014 OR: 1.39, P < .001). Biopsy was associated with a reduced risk of positive margins in patients with clinical T1 stage (OR: 0.70, P = .012), and younger than 61 (OR: 0.79, P = .036). The national rate of preoperative biopsy in parotid malignancy is low at 26.0%, but has increased over time. Preoperative biopsy is associated with a reduced risk of positive margins in younger patients and those with early clinical stage, suggesting its increased use may improve surgical outcomes and decrease reoperation or adjuvant therapy in these subgroups of patients. 3 Laryngoscope, 130:1450-1458, 2020.

Abstract P3-13-03: Risk factors for reoperation following breast-conserving surgery integrated into pre- and postoperative models with high accuracy

Abstract Purpose: Breast-conserving surgery (BCS) is today applied in 60-70% of patients with invasive and in situ cancer and tumor size of 3 cm or less. However, a significant fraction of patients (10-40%) who undergo BCS require a reoperation due to incomplete excision of the tumor despite the evolvement of oncoplastic surgical techniques. We aimed to define risk factors for non-radical BCS due to positive margins in patients with in situ and invasive breast cancer operated with BCS. A specific focus was to identify preoperatively available characteristics which could be informative for the surgeon and patients when planning the primary choice of breast surgery. Methods: Patients with final diagnosis of in situ or invasive cancer who underwent BCS 2015-2016 at Skåne University Hospital in Malmö were included in the study. Patients undergoing neoadjuvant therapy were excluded. Data was extracted from mammography/ultrasound files, type of surgery from clinical files and pre-and postoperative pathological diagnosis and radicality from pathological files according to a prespecified protocol. The definition of radicality was according to international consensus (ie no tumor on ink for invasive cancer and 2 mm for in situ cancer).Uni- and multivariable logistic regression analysis were executed separately for pre- and postoperatively available parameters in the SPSS software to calculate odds ratios (OR) for predictors of non-radicality. Separate models for pre- and postoperative characteristics were defined based on data derived in 2015, 2016 was used as a validation set. Accuracy of the models were presented as AUC-values. P-values of ≤0.05 were considered significant. Results: 202 patients diagnosed in 2015 were included of which 43 (21.3%) patients were considered non-radically operated, whereas 231 patients diagnosed in 2016 were eligible and had a reoperation rate of 14.3%. Multivariable analysis included determinants from the univariate analysis and clinically relevant variables with the following results for the preoperative model: mammographic size per mm: OR 1.06 (95% CI:1.01-1.11), p=0.014 , invasive lobular cancer on core needle biopsy vs not: OR 7.3 (95% CI: 1.8-29.4), P=0.005, DCIS diagnosis on core needle biopsy vs not OR 3.60 (95% CI: 1.00-13.02) p=0.051, benign core needle biopsy vs not OR 6.3 (95% CI: 0.9-46.7), p=0.070, oncoplastic surgery and presence of calcifications had p-values &amp;gt; 0.1. In the postoperative model pure DCIS in the specimen and total extent were significant predictive factors in the multivariate analysis. The preoperative model predicting non-radicality had an AUC of 0.81 and the postoperative model had an AUC of 0.86 in the test set (year 2015), the AUC in the validation set (year 2016) was 0.80 for the preoperative model and 0.81 for the postoperative model. Conclusion: Important preoperative prediction factors for non-radicality following BCS derived from core needle biopsies and mammograms have shown promising results and may be helpful when planning the primary choice of breast surgery. An extended study with larger cohort size is desirable. Citation Format: Ellrant J, Plassgård E, Bendahl P-O, Rydén L. Risk factors for reoperation following breast-conserving surgery integrated into pre- and postoperative models with high accuracy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-13-03.

Abstract P3-13-02: Breast conserving therapy after neoadjuvant systemic therapy in patients with T3 breast cancer is feasible

Abstract Background An important advantage of neoadjuvant systemic therapy (NST) in breast cancer patients is down-sizing of the primary tumor. However, many patients with T3 tumors are treated with mastectomy regardless of response to NST. In this study, we evaluated predictive characteristics for positive margins and local control in T3 breast cancer patients who underwent breast-conserving therapy (BCT) after NST. Methods This single institution study included all clinical T3 breast cancer patients (determined by contrast-enhanced magnetic resonance imaging [MRI]) who underwent breast conserving surgery (BCS) after NST between 2000-2015. Clinical T3 was defined as a breast tumor &amp;gt;50mm on MRI pre-NST. Patient, tumor and treatment characteristics were recorded, as well as response on MRI and final pathology. The local recurrence probability was estimated with the Kaplan-Meier method. Predictive characteristics for positive margins in patients undergoing BCS were analyzed using Fishers exact test. Results In total, 115 T3 patients were identified. Patient, tumor and MRI findings are presenting in the table. Median tumor size was 60 mm on MRI pre-NST (range 51-120 mm) and 4 mm after NST (range 0-58 mm). Overall pathologic complete response was 19%: 5% in HR+/HER2- patients, 32% in HR-/HER2+ patients and 40% in TN patients. After initial BCS, 73 patients had negative margins (63.5%), 18 focally positive margins (15.7%) and 24 more than focally positive margins (20.9%). Patients with HR+/HER2- tumors (52%) were more likely to have positive margins than patients with HR-/HER2+ and TN tumors (21% and 19%, p=0.002). In addition, positive margins rate was higher in patients with lobular carcinoma compared to patients with ductal carcinoma (57 vs 32%, p=0.031). Presence of non-mass enhancement on pre-NST MRI was predictive for positive margins (52% in patients with and 25% in patients without non-mass enhancement, p=0.003). Of patient with positive margins, 15 underwent radiotherapy with boost, 6 underwent re-excision and 21 underwent mastectomy. Finally, 94/115 patients were treated with BCT (82%). Of these patients, two had a local recurrence after a median follow-up of 6.5 years (6-year local recurrence probability 2.6% (95%-CI 0-7%). Conclusion In this series, BCT after NST was successful in 82% of patients with T3 breast cancer and local control in this group was excellent. The positive margin rate after BCS was higher in patients with HR+ tumors, lobular carcinoma and tumors with non-mass enhancement on MRI pre-NST. BCT should always be considered in T3 cancers after NST. CharacteristicTotal (n=115)Positive margins (focally+ &amp;gt;focally), n=42(%)p-valueHistology 0.031Ductal9229(32) Lobular2313(57) Subtype 0.002HR+/HER2-6132(52) HER2+347(21) TN203(15) MRI morphology of mass pre-NST 0.948Unifocal288(29) Multifocal4012(33) Multicentric134(31) Only non-mass enhancement34 MRI non-mass enhancement before NST 0.003Absent6516(25) Present5026(52) MRI response after NST 0.952rCR5218(35) non-rCR6221(38) Missing1 Citation Format: van der Noordaa ME, Vrancken Peeters M-JM, Ioan I, Loo CE, van Urk J, van Werkhoven E, Voorthuis R, Wiersma T, Groen E, Rutgers ET, van Duijnhoven FH. Breast conserving therapy after neoadjuvant systemic therapy in patients with T3 breast cancer is feasible [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-13-02.