Browsing by Author "Selin, Nils"

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    Predictive factors for residual disease in non-radical breast cancer surgery
    (2022-02-23) Selin, Nils; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
    Background Breast cancer is the cancer type affecting the most women and it causes substantial suffering to those affected. Surgery is usually the primary treatment and it is performed with the goal of removing the entire tumour. If the tumour was not completely excised in the first operation, the patient may undergo a reoperation to remove the residual tumour. Despite the tumour not being radically excised in a subset of the first operations, no residual tumour is found in approximately 23-67% of the women being reoperated, which means that the reoperation had no therapeutic effect. Identifying factors that influence the probability of residual tumour could help prevent patients from undergoing unnecessary surgery. Aim The aim of the study was to examine how many patients underwent reoperation at Sahlgrenska University Hospital due to close or non-radical margins, the incidence of residual tumour upon re-excision and what factors can predict the probability of residual tumour upon reoperation. Method The study period ranged from January 2008 to December 2018. During this period, approximately 6670 women underwent operations due to breast cancer at Sahlgrenska University Hospital. A list of the 334 women who were reoperated at the hospital in the same period was obtained from NKBC (the national registry of breast cancer). Information from the patient’s preoperative statement, operation, reoperation and additional treatment was gathered from the medical records. The list of patients was curated and 60 patients were excluded from the study, rendering 274 patients eligible for analysis. The influence of patient age, Ki67-grade, NHG-grade, histologic tumour-type, tumour size, presence of a DCIS- component (ductal carcinoma in situ) and multifocality on the likelihood of residual tumour was analysed using univariate and multivariate logistic regression. Results Between January 2008 and December 2018, 274 women underwent reoperation due to close or non-radical margins at Sahlgrenska University Hospital within three months of the first operation. Out of the 274 women, 62 had pure DCIS-tumours while 208 had invasive cancer. A total of 51 (82.3%) women had residual tumour following surgery for a DCIS-tumour while the corresponding number for the women diagnosed with invasive cancer was 151 (72.6%). The probability of residual tumour for patients who underwent their first operation at Sahlgrenska University Hospital for the two categories combined was 73.5%. For invasive cancers, patient age and the presence of a DCIS-component were statistically significant independent predictors of residual tumour upon reoperation. The probability decreased with patient age (OR = 0.967, 95% CI = 0.940 – 0995, p = 0.021) but increased if the tumour had a DCIS-component (OR = 2.828, 95% CI = 1.271 – 6.292, p = 0.011). Age was not a statistically significant predictor in patients diagnosed with DCIS. Conclusion A DCIS-component along with patient age influences the probability of residual tumour following an operation for invasive cancer. Neither patient age nor tumour size were independent predictors in patients with pure DCIS-tumours. The study was retrospective in nature and had a set of limitations impacting the reliability of the results. Additional large-scale studies investigating what parameters can be used to predict the probability of residual tumour are required before reconsidering clinical guidelines.