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The Relationship Between Margin Width And Local Recurrence (LR) Of Ductal Carcinoma In Situ (DCIS): 3001 Women Treated With Breast-conserving Surgery (BCS) Over 30 Years
Kimberly J Van Zee, Preeti D Subhedar*, Cristina Olcese*, Sujata Patil*, Monica Morrow
Memorial Sloan Kettering Cancer Center, New York, NY

OBJECTIVE:While DCIS has minimal mortality, LR rates after BCS remain significant, and half of LR are invasive. Positive margins are associated with increased risk of LR, but there is no consensus regarding optimal margin width. Our goal was to investigate the relationship between margin width and LR in a large population of women with long follow-up.
METHODS:We retrospectively reviewed a prospective database of DCIS patients undergoing BCS from 1978-2010. Cox proportional hazard models were used to investigate the association between margin width and LR.
RESULTS:3001 women were identified; 2713 had complete data. 324 recurred. Median follow-up for women without LR was 74mo(range 0-30years); 680 were followed for ≥10yrs. Controlling for age(p<0.001), family history(p=0.02), clinical vs. radiologic presentation(p=0.02), number of excisions(p=0.006), radiotherapy(RT)(p<0.0001), endocrine therapy(p<0.0001), and year of surgery(p=0.002), margin width was significantly associated with LR(p=0.0004) in the entire population. Larger negative margins were associated with lower hazard ratio(HR) compared to positive margins(Table). An interaction between RT and margin width was significant(p<0.02); the association of LR with margin width was significant in those without RT(p<0.0001)(Table), but not in those with RT(p=0.9).
CONCLUSIONS:In women not receiving RT, margin width was significantly associated with LR, with wider margins resulting in a significantly lower rate of LR. Obtaining wider negative margins may be important in reducing the risk of LR in women who choose not to undergo RT.

Relationship of margin width and LR in Cox proportional hazards models controlling for other factors
Population in modelMargin widthHazard ratioP
Entire population (N=2713)Positive10.0004
<=2mm0.81
>2-10mm0.73
>10mm0.46
No radiotherapy population (N=1229)Positive1<0.0001
<=2mm0.76
>2-10mm0.59
>10mm0.31


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