Retrospective, Multicenter Analysis Comparing Conventional with Oncoplastic Breast Conserving Surgery: Oncological and Surgical Outcomes in Women with High-Risk Breast Cancer from the OPBC-01/iTOP2 Study
Florian Fitzal, Michael Bolliger, Daniela Dunkler, Angelika Geroldinger, Luca Gambone, Jörg Heil, Fabian Riedel, Jana de Boniface, Camilla André, Zoltán Mátrai, Dávid Pukancsik, Régis Resende Paulinelli, Valerijus Ostapenko, Arvydas Burneckis, Andrej Ostapenko, Edvin Ostapenko, Francesco Meani, Yves Harder, Marta Bonollo, Andrea Alberti, Christoph Tausch, Bärbel Papassotiropoulos, Ruth Helfgott, Dietmar Heck, Hans-Jörg Fehrer, Markus Acko, Peter Schrenk, Elisabeth Trapp, Gunda Pristauz-Telsnigg, Paliczek Clara, Giacomo Montagna, Mathilde Ritter, Jens‐Uwe Blohmer, Steffen Sander, László Romics, Elizabeth Morrow, Katharina Lorenz, Mathias K. Fehr, William P. Weber
Abstract
INTRODUCTION: Recent data suggest that margins ≥2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). By allowing large resection volumes, oncoplastic breast-conserving surgery (OBCII; Clough level II/Tübingen 5-6) may achieve better local control than conventional breast conserving surgery (BCS; Tübingen 1-2) or oncoplastic breast conservation with low resection volumes (OBCI; Clough level I/Tübingen 3-4). METHODS: Data from consecutive high-risk BC patients treated in 15 centers from the Oncoplastic Breast Consortium (OPBC) network, between January 2010 and December 2013, were retrospectively reviewed. RESULTS: A total of 3,177 women were included, 30% of whom were treated with OBC (OBCI n = 663; OBCII n = 297). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs. 37%, p = 0.002; proportion with margin <1 mm: 17% vs. 6%, p < 0.001). There were significantly more re-excisions due to R1 ("ink on tumor") in the BCS/OBCI compared with the OBCII group (11% vs. 7%, p = 0.049). Univariate and multivariable regression analysis adjusted for tumor biology, tumor size, radiotherapy, and systemic treatment demonstrated no differences in local, regional, or distant recurrence-free or overall survival between the two groups. CONCLUSIONS: Large resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI.