TRIPLE NEGATIVE AND OTHERS OPERABLE BREAST TUMORS: HOW NOT TO MAKE THE BAD GET WORSE

Background: The positivity of the surgical margin (SM+) due to neoplasia has a negative impact. This study analyzed whether there is any subgroup with greater damage. Methods: 678 women with invasive breast cancer was analyzed in this retrospective study. Survival was analyzed by Kaplan-Meier method. Multivariate analyses (p*) by Cox regression method for independent prognostic factors for death, distant metastases-free survival (M1) and locoregional (LR)- free survival versus SM+ was performed. Results: Seventy-seven (11.35%) patients had SM+, with no difference between of radical or conservative surgery. The SM+ caused 2.2 times more risk of LR (p* = 0.046); 1.74 times more risk of M1 (univariate analysis, p = 0.036) and 1.81 more risk of death (univariate analysis, p = 0.027). In subgroup analysis the stage II (357 patients; 40 MS+ presented 2.79 times more risk of LR (p* = 0.029) and 2 times more risk of M1 (multivariate analysis, p = 0.030). But within stage II under strict analysis in those patients with negative axillary lymph nodes (T2N0) there was an intensification of the risk, with 11.4 times more risk of LR (p* = 0.001); 4.6 times more risk of M1 (p* = 0.011); and 4.6 times more risk of death (univariate analysis, p = 0.011). In the analysis of the molecular subgroup (Luminal A and B, HER2 and TN) there was no significant difference in the rate of surgical resection with a SM+. TN tumors with a MS+ had 6 times more risk of LR (p* = 0.002) and 2.3 times more risk of death (univariate analysis, p = 0.044). Patients with HER2 + tumors with SM+ were 1.9 times more at risk for M1 (univariate analysis, p = 0.043). The largest number of positive axillary lymph nodes (N+) was in Luminal B tumors (50%) with statistical difference (p = 0.0198). In TN tumors 45% was N+(HER2 43.2% N+ and Luminal A 36.2% N+). In the quantitative analysis of axillary lymph nodes (N0, N1, N2 or N3) there was also a significant difference: Luminal tumors showed more N0 or N1, but TN and HER2 showed equal qualitative distribution between N0, N1, N2 and N3. Conclusions: If there are doubts about the possibility of achieving a negative margin in invasive breast cancer surgery, preoperative cytoreduction should always be offered, avoiding the violation of the tumor microenvironment. The positive surgical margin, especially in TN and HER2 + and T2N0 tumors, negatively impacts the patient’s evolution.