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

Authors Pan Z, Zhu L, Li Q, Lai J, Peng J, Su F, Li S, Chen K

Received 20 December 2017

Accepted for publication 21 March 2018

Published 8 May 2018 Volume 2018:11 Pages 2627—2635

DOI https://doi.org/10.2147/OTT.S160433

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Cho


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
 

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