导管癌原位边缘共识指南实施对再切除率、满意度和成本的影响。,Annals of Surgical Oncology

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导管癌原位边缘共识指南实施对再切除率、满意度和成本的影响。
Annals of Surgical Oncology ( IF 3.4 ) Pub Date : 2021-05-27 , DOI: 10.1245/s10434-021-10120-z
Neal Bhutiani ₁ , Michelle M Holland ₁ , Megan K Mercer ₁ , Marilyn Donaldson ₁ , Tiffany S Berry ₂ , Kelly M McMasters ₁ , Nicolás Ajkay ₁

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引言 2016 年关于导管原位癌 (DCIS) 全乳放疗 (WBI) 保乳手术 (BCS) 边缘的共识指南推荐 2 mm 边缘以降低局部复发率。我们检查了指南实施前后的再切除率、成本和患者满意度。方法从机构审查委员会批准的数据库中，对在一个学术机构和一个社区癌症中心接受 BCS 随访超过 1 年的 DCIS 患者进行评估。根据接受治疗的时间，即在 2016 年 11 月之前（共识前 [PRE]）和 2016 年 11 月之后（共识后 [POST]），就结果和成本参数对两组进行比较。结果共识指南实施后，再次切除率（32.1% vs. 20.0%）和全乳中转率（8.3% vs. 2. 3%) 显着增加，尽管总切除量、每位患者的手术费用和对乳房评分的满意度没有差异。并非所有切缘 <2 mm 的患者都被再次切除，尽管该亚组的再次切除率显着增加（62.4% 对 31.3%）。在控制年龄、雌激素受体状态、WBI 使用和切缘状态的多变量分析中，共识指南发布后的手术与较高的再切除率独立相关（优势比 [OR] 1.97，95% 置信区间 [CI] 1.08- 3.59，p = 0.03）和更高的乳房切除转换率（OR 6.84，95% CI 1.67-28.00，p = 0.007）。结论 2016 年 DCIS 边缘共识指南的实施导致两个机构的再次切除和乳房切除术转换增加。

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Effect of the Ductal Carcinoma In Situ Margin Consensus Guideline Implementation on Re-Excision Rates, Satisfaction, and Cost.

INTRODUCTION The 2016 consensus guideline on margins for breast-conserving surgery (BCS) with whole-breast irradiation (WBI) for ductal carcinoma in situ (DCIS) recommended 2 mm margins to decrease local recurrence rates. We examined re-excision rates, cost, and patient satisfaction before and after guideline implementation. METHODS From an Institutional Review Board-approved database, patients with DCIS who underwent BCS with over 1 year of follow-up at one academic institution and one community cancer center were evaluated. Two groups were compared based on when they received treatment, i.e. before (pre-consensus [PRE]) and after November 2016 (post consensus [POST]), with respect to outcome and cost parameters. RESULTS After consensus guideline implementation, re-excision rate (32.1% vs. 20.0%) and mastectomy conversion (8.3% vs. 2.3%) significantly increased, although total resection volume, operative cost per patient, and satisfaction with breast scores did not differ. Not all patients with <2 mm margins were re-excised, although the re-excision rate among this subset significantly increased (62.4% vs. 31.3%). On multivariable analysis controlling for age, estrogen receptor status, WBI use, and margin status, surgery after consensus guideline publication was independently associated with a higher re-excision rate (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.08-3.59, p = 0.03) and a higher rate of conversion to mastectomy (OR 6.84, 95% CI 1.67-28.00, p = 0.007). CONCLUSIONS Implementation of the 2016 margin consensus guideline for DCIS resulted in an increase in re-excisions and mastectomy conversions at two institutions. Research is needed for operative tools and strategies to decrease DCIS re-excision rates.

更新日期：2021-05-27

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