Skip to main content

Advertisement

SpringerLink
Log in

Local Recurrence of Benign, Borderline, and Malignant Phyllodes Tumors of the Breast: A Systematic Review and Meta-analysis

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This systematic review and meta-analysis aimed to investigate local recurrence (LR) rates among the three grades (benign, borderline, and malignant) of phyllodes tumors (PTs). The study also assessed various risk factors for LR.

Methods

Electronic articles published between 1 January 1995 and 31 May 2018, were searched and critically appraised. The authors independently reviewed the abstracts and extracted data for LR rates and LR risk factors.

Results

The review incorporated 54 studies with 9234 individual cases. The pooled LR rates were 8% for benign, 13% for borderline, and 18% for malignant PTs. The risk of LR was significantly increased by borderline versus benign PTs (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.68–2.38) and malignant versus borderline PTs (OR 1.28; 95% CI 1.05–1.55). The significant risk factors for LR were mitoses, tumor border (infiltrating vs. pushing), stromal cellularity (moderate/severe vs. mild), stromal atypia (severe vs. mild/absent), stromal overgrowth (severe vs. mild/absent), and tumor necrosis (positive vs. negative). Age and tumor size were not associated with LR risk. The subgroup analysis showed that breast-conserving surgery versus mastectomy and positive versus negative surgical margins were significantly associated with an increased LR risk only in malignant PTs.

Conclusions

The risk of LR was significantly increased from benign to borderline to malignant PTs. Mitoses, tumor border, stromal cellularity, stromal atypia, stromal overgrowth, tumor necrosis, type of surgery, and surgical margin status may be risk factors for LR. Different management strategies could be considered for different PT grades.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Krishnamurthy S, Ashfaq R, Shin HJ, et al. Distinction of phyllodes tumor from fibroadenoma: a reappraisal of an old problem. Cancer. 2000;90:342–9.

    Article  CAS  PubMed  Google Scholar 

  2. Rosen P, Overman H. Cystosarcoma phyllodes. In: Rosai J, Sobin L, editors. Atlas of tumor pathology. Tumors of the mammary gland. 3rd ed. Washington, DC: Armed Forces Institute of Pathology; 1993. pp. 107–14.

    Google Scholar 

  3. Azzopardi JG, Ahmed A, Millis RR. Problems in breast pathology. Major Probl Pathol. 1979;11:1–466.

    Google Scholar 

  4. Barrio AV, Clark BD, Goldberg JI, et al. Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol. 2007;14:2961–70.

    Article  PubMed  Google Scholar 

  5. Kario K, Maeda S, Mizuno Y, et al. Phyllodes tumor of the breast: a clinicopathologic study of 34 cases. J Surg Oncol. 1990;45:46–51.

    Article  CAS  PubMed  Google Scholar 

  6. Ward RM, Evans HL. Cystosarcoma phyllodes: a clinicopathologic study of 26 cases. Cancer. 1986;58:2282–9.

    Article  CAS  PubMed  Google Scholar 

  7. Pietruszka M, Barnes L. Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases. Cancer. 1978;41:1974–83.

    Article  CAS  PubMed  Google Scholar 

  8. Co M, Chen C, Tsang JY, et al. Mammary phyllodes tumour: a 15-year multicentre clinical review. J Clin Pathol. 2018;71:493–7.

    Article  PubMed  Google Scholar 

  9. Matos AN, Neto J, Antonini, M, Ferraro O, Mancinelli B, Pereira A, Lopes R. Phyllodes tumors of the breast: a retrospective evaluation of cases from the hospital do servidor público estadual de São Paulo. Mastology. 2017;27:339–43.

    Article  Google Scholar 

  10. Guillot E, Couturaud B, Reyal F, et al. Management of phyllodes breast tumors. Breast J. 2011;17:129–37.

    Article  PubMed  Google Scholar 

  11. Chaney AW, Pollack A, McNeese MD, et al. Primary treatment of cystosarcoma phyllodes of the breast. Cancer. 2000;89:1502–11.

    Article  CAS  PubMed  Google Scholar 

  12. Ganesh V, Drost L, Lee J, et al. A retrospective review of phyllodes tumours of the breast: a single-institution experience. Breast. 2018;38:52–7.

    Article  PubMed  Google Scholar 

  13. Jung C-W, Suh K-S, Lee J-S, et al. Mutation-free expression of c-Kit and PDGFRA in phyllodes tumors of the breast. J Breast Cancer. 2010;13:257.

    Article  Google Scholar 

  14. Kim HM, Lee YK, Koo JS. Expression of CAF-related proteins is associated with histologic grade of breast phyllodes tumor. Dis Markers. 2016;2016:4218989.

    PubMed  PubMed Central  Google Scholar 

  15. Kim S, Kim JY, Kim DH, et al. Analysis of phyllodes tumor recurrence according to the histologic grade. Breast Cancer Res Treat. 2013;141:353–63.

    Article  PubMed  Google Scholar 

  16. Narayanakar RP, Gangaiah DM, Althaf S, et al. Cystosarcoma phyllodes: pathological enigma: a retrospective review of 162 cases. Indian J Cancer. 2015;52:365–8.

    Article  CAS  PubMed  Google Scholar 

  17. Wang K, Li Q, Shi R, et al. Increased CD105 expression is associated with disease progression in phyllodes tumors: a report of a borderline phyllodes tumor with lung metastases and a study of 54 phyllodes tumors. Ann Diagn Pathol. 2018;32:4–9.

    Article  PubMed  Google Scholar 

  18. Zhou ZR, Wang CC, Sun XJ, et al. Prognostic factors in breast phyllodes tumors: a nomogram based on a retrospective cohort study of 404 patients. Cancer Med. 2018;7:1030–42.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Yom CK, Han W, Kim SW, et al. Reappraisal of conventional risk stratification for local recurrence based on clinical outcomes in 285 resected phyllodes tumors of the breast. Ann Surg Oncol. 2015;22:2912–8.

    Article  PubMed  Google Scholar 

  20. Spitaleri G, Toesca A, Botteri E, et al. Breast phyllodes tumor: a review of literature and a single-center retrospective series analysis. Crit Rev Oncol Hematol. 2013;88:427–36.

    Article  PubMed  Google Scholar 

  21. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  PubMed  Google Scholar 

  22. StataCorp. Stata statistical software: release 14. College Station, PA: StataCorp LP; 2015.

    Google Scholar 

  23. Copenhagen: The Nordic Cochrane Centre. Review manager (RevMan). 5.1 ed. Oxford: The Cochrane Collaboration; 2011.

    Google Scholar 

  24. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. Oxford: The Cochrane Collaboration; 2011.

    Google Scholar 

  25. Phillips B, Ball C, Sackett D, et al. Levels of evidence and grades of recommendation. Oxford Centre for Evidence-Based Medicine website, March 2009, 2015. http://www.cebm.net/index.aspx?o=1025. Accessed 27 June 2015.

  26. Borhani-Khomani K, Talman ML, Kroman N, et al. Risk of local recurrence of benign and borderline phyllodes tumors: a Danish population-based retrospective study. Ann Surg Oncol. 2016;23:1543–8.

    Article  PubMed  Google Scholar 

  27. Cheng SP, Chang YC, Liu TP, et al. Phyllodes tumor of the breast: the challenge persists. World J Surg. 2006;30:1414–21.

    Article  PubMed  Google Scholar 

  28. Chng TW, Gudi M, Lim SH, et al. Validation of the Singapore nomogram for outcome prediction in breast phyllodes tumours in a large patient cohort. J Clin Pathol. 2018;71:125–8.

    Article  PubMed  Google Scholar 

  29. Sotheran W, Domjan J, Jeffrey M, et al. Phyllodes tumours of the breast: a retrospective study from 1982 to 2000 of 50 cases in Portsmouth. Ann R Coll Surg Engl. 2005;87:339–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Tan PH, Thike AA, Tan WJ, et al. Predicting clinical behaviour of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins. J Clin Pathol. 2012;65:69–76.

    Article  PubMed  Google Scholar 

  31. Choi N, Kim K, Shin KH, et al. Malignant and borderline phyllodes tumors of the breast: a multicenter study of 362 patients (KROG 16-08). Breast Cancer Res Treat. 2018;171:335–44.

    Article  PubMed  Google Scholar 

  32. Huang C-C, Liu T-P, Cheng S-P, et al. Surgical treatment of phyllodes tumor of the breast with the trend. J Exp Clin Med. 2014;6:161–5.

    Article  Google Scholar 

  33. Karim RZ, Gerega SK, Yang YH, et al. Phyllodes tumours of the breast: a clinicopathological analysis of 65 cases from a single institution. Breast. 2009;18:165–70.

    Article  CAS  PubMed  Google Scholar 

  34. Moutte A, Chopin N, Faure C, et al. Surgical management of benign and borderline phyllodes tumors of the breast. Breast J. 2016;22:547–52.

    Article  PubMed  Google Scholar 

  35. Rodrigues MF, Truong PT, McKevitt EC, et al. Phyllodes tumors of the breast: the British Columbia Cancer Agency experience. Cancer Radiother. 2018;22:112–9.

    Article  CAS  PubMed  Google Scholar 

  36. Ruvalcaba-Limon E, Jimenez-Lopez J, Bautista-Pina V, et al. Phyllodes tumor of the breast: 307 treated cases, the largest Mexican experience at a single breast disease institution. Iran J Pathol. 2016;11:399–408.

    PubMed  PubMed Central  Google Scholar 

  37. Akrami M, Tahmasebi S, Talei A, et al. Clinical outcome of patients with breast phyllodes tumors: a retrospective analysis of 129 cases in Shiraz, Southern Iran. Middle East J Cancer. 2015;6:267–73.

    Google Scholar 

  38. Amy L. A single-center experience and review of the literature: 64 cases of phyllodes tumors to better understand risk factors and disease management. Am Surg. 2014;81:309–15.

    Google Scholar 

  39. Asoglu O, Ugurlu MM, Blanchard K, et al. Risk factors for recurrence and death after primary surgical treatment of malignant phyllodes tumors. Ann Surg Oncol. 2004;11:1011–7.

    Article  PubMed  Google Scholar 

  40. Belkacemi Y, Bousquet G, Marsiglia H, et al. Phyllodes tumor of the breast. Int J Radiat Oncol Biol Phys. 2008;70:492–500.

    Article  PubMed  Google Scholar 

  41. Bellezza G, Prosperi E, Del Sordo R, et al. IMP3 is strongly expressed in malignant phyllodes tumors of the breast: an immunohistochemical study. Int J Surg Pathol. 2016;24:37–42.

    Article  CAS  PubMed  Google Scholar 

  42. Ben Hassouna J, Damak T, Gamoudi A, et al. Phyllodes tumors of the breast: a case series of 106 patients. Am J Surg. 2006;192:141–7.

    Article  PubMed  Google Scholar 

  43. Chen WH, Cheng SP, Tzen CY, et al. Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol. 2005;91:185–94.

    Article  PubMed  Google Scholar 

  44. Hassan MA, Sakr MA. Predictive factors of local recurrence and survival following primary surgical treatment of phyllodes tumors of the breast. J Egypt Nat. 2006;18:125–33.

    Google Scholar 

  45. Ho SK, Thike AA, Cheok PY, et al. Phyllodes tumours of the breast: the role of CD34, vascular endothelial growth factor and beta-catenin in histological grading and clinical outcome. Histopathology. 2013;63:393–406.

    Article  PubMed  Google Scholar 

  46. Jang JH, Choi MY, Lee SK, et al. Clinicopathologic risk factors for the local recurrence of phyllodes tumors of the breast. Ann Surg Oncol. 2012;19:2612–7.

    Article  PubMed  Google Scholar 

  47. Kim G-E, Ki J-H, Lee KH, et al. Stromal matrix metalloproteinase-14 expression correlates with the grade and biological behavior of mammary phyllodes tumors. Appl Immunohistochem Mol Morphol. 2012;20:298–303.

    Article  CAS  PubMed  Google Scholar 

  48. Moo TA, Alabdulkareem H, Tam A, et al. Association between recurrence and re-excision for close and positive margins versus observation in patients with benign phyllodes tumors. Ann Surg Oncol. 2017;24:3088–92.

    Article  PubMed  Google Scholar 

  49. Ng CC, Tan J, Ong CK, et al. MED12 is frequently mutated in breast phyllodes tumours: a study of 112 cases. J Clin Pathol. 2015;68:685–91.

    Article  CAS  PubMed  Google Scholar 

  50. Niezabitowski A, Lackowska B, Rys J, et al. Prognostic evaluation of proliferative activity and DNA content in the phyllodes tumor of the breast: immunohistochemical and flow cytometric study of 118 cases. Breast Cancer Res Treat. 2001;65:77–85.

    Article  CAS  PubMed  Google Scholar 

  51. Ouyang Q, Li S, Tan C, et al. Benign phyllodes tumor of the breast diagnosed after ultrasound-guided vacuum-assisted biopsy: surgical excision or wait-and-watch? Ann Surg Oncol. 2016;23:1129–34.

    Article  PubMed  Google Scholar 

  52. Ramakant P, Chakravarthy S, Cherian JA, et al. Challenges in management of phyllodes tumors of the breast: a retrospective analysis of 150 patients. Indian J Cancer. 2013;50:345–8.

    Article  CAS  PubMed  Google Scholar 

  53. Reinfuss M, Mitus J, Duda K, et al. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer. 1996;77:910–16.

    Article  CAS  PubMed  Google Scholar 

  54. Renner K, Holzer B, Minai-Pour M, et al. Phyllodes tumours of the breast. Eur Surg. 2005;37:327–30.

    Article  Google Scholar 

  55. Sevinc AI, Aksoy SO, Guray Durak M, et al. Is the extent of surgical resection important in patient outcome in benign and borderline phyllodes tumors of the breast? Turk J Med Sci. 2018;48:28–33.

    Article  PubMed  Google Scholar 

  56. Slodkowska E, Nofech-Mozes S, Xu B, et al. Fibroepithelial lesions of the breast: a comprehensive morphological and outcome analysis of a large series. Mod Pathol. 2018;31:1073–84.

    Article  PubMed  Google Scholar 

  57. Tremblay-LeMay R, Hogue JC, Provencher L, et al. How wide should margins be for phyllodes tumors of the breast? Breast J. 2017;23:315–22.

    Article  PubMed  Google Scholar 

  58. Tsang JY, Mendoza P, Putti TC, et al. E-cadherin expression in the epithelial components of mammary phyllodes tumors. Hum Pathol. 2012;43:2117–23.

    Article  CAS  PubMed  Google Scholar 

  59. Varghese SS, Sasidharan B, Manipadam MT, et al. Radiotherapy in phyllodes tumour. J Clin Diagn Res. 2017;11:XC01–03.

    PubMed  PubMed Central  Google Scholar 

  60. Wang F, Jia Y, Tong Z. Comparison of the clinical and prognostic features of primary breast sarcomas and malignant phyllodes tumor. Jpn J Clin Oncol. 2015;45:146–52.

    Article  PubMed  Google Scholar 

  61. Wang H, Wang X, Wang C-F. Comparison of clinical characteristics between benign borderline and malignant phyllodes tumors of the breast. Asian Pac J Cancer Prev. 2014;15:10791–5.

    Article  PubMed  Google Scholar 

  62. Wei J, Tan YT, Cai YC, et al. Predictive factors for the local recurrence and distant metastasis of phyllodes tumors of the breast: a retrospective analysis of 192 cases at a single center. Chin J Cancer. 2014;33:492–500.

    PubMed  PubMed Central  Google Scholar 

  63. Xiao M, Zhu Q, Jiang Y, et al. Local recurrent phyllodes tumors of the breast: clinical and sonographic features. J Ultrasound Med. 2015;34:1631–8.

    Article  PubMed  Google Scholar 

  64. Yamada I, Iino Y, Yokoe T. Phyllodes tumors of the breast: a clinicopathological study of 118 cases. Surg Today. 1997;27:1137–43.

    Article  Google Scholar 

  65. Zissis C, Apostolikas N, Konstantinidou A, et al. The extent of surgery and prognosis of patients with phyllodes tumor of the breast. Breast Cancer Res Treat. 1998;48:205–10.

    Article  CAS  PubMed  Google Scholar 

  66. Tan PH, Jayabaskar T, Chuah KL, et al. Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol. 2005;123:529–40.

    Article  PubMed  Google Scholar 

  67. Lakhani S, Ellis I, Schnitt S, et al. WHO classification of tumours of the breast. Geneva: World Health Organization; 2012.

    Google Scholar 

  68. Lae M, Vincent-Salomon A, Savignoni A, et al. Phyllodes tumors of the breast segregate in two groups according to genetic criteria. Mod Pathol. 2007;20:435–44.

    Article  CAS  PubMed  Google Scholar 

  69. Tan J, Ong CK, Lim WK, et al. Genomic landscapes of breast fibroepithelial tumors. Nat Genet. 2015;47:1341–5.

    Article  CAS  PubMed  Google Scholar 

  70. Koh VCY, Thike AA, Nasir NDM, et al. Size and heterologous elements predict metastases in malignant phyllodes tumours of the breast. Virchows Arch. 2017;472:615–21.

    Article  PubMed  Google Scholar 

  71. Salvadori B, Cusumano F, Del Bo R, et al. Surgical treatment of phyllodes tumors of the breast. Cancer. 1989;63:2532–6.

    Article  CAS  PubMed  Google Scholar 

  72. de Roos WK, Kaye P, Dent DM. Factors leading to local recurrence or death after surgical resection of phyllodes tumours of the breast. Br J Surg. 1999;86:396–9.

    Article  PubMed  Google Scholar 

  73. Rageth CJ, O’Flynn EA, Comstock C, et al. First international consensus conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat. 2016;159:203–13.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Cowan ML, Argani P, Cimino-Mathews A. Benign and low-grade fibroepithelial neoplasms of the breast have low recurrence rate after positive surgical margins. Mod Pathol. 2016;29:259–65.

    Article  CAS  PubMed  Google Scholar 

  75. Park HL, Kwon SH, Chang SY, et al. Long-term follow-up result of benign phyllodes tumor of the breast diagnosed and excised by ultrasound-guided vacuum-assisted breast biopsy. J Breast Cancer. 2012;15:224–9.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Zurrida S, Bartoli C, Galimberti V, et al. Which therapy for unexpected phyllode tumour of the breast? Eur J Cancer. 1992;28:654–7.

    Article  CAS  PubMed  Google Scholar 

  77. Zeng S, Zhang X, Yang D, et al. Effects of adjuvant radiotherapy on borderline and malignant phyllodes tumors: a systematic review and meta-analysis. Mol Clin Oncol. 2015;3:663–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Kim YJ, Kim K. Radiation therapy for malignant phyllodes tumor of the breast: an analysis of SEER data. Breast. 2017;32:26–32.

    Article  PubMed  Google Scholar 

  79. Blichert-Toft M, Hansen JP, Hansen OH, et al. Clinical course of cystosarcoma phyllodes related to histologic appearance. Surg Gynecol Obstet. 1975;140:929–32.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgment

This study was supported by grants from the National Key Research and Development Program of China (2017YFC1309100), the National Natural Science Foundation of China (Grant Nos. 81402201, 81372817), the National Natural Science Foundation of Guangdong Province (Grant Nos. 2014A030310070, 2017A030313705), the China Postdoctoral Science Foundation (Grant No. 2018M633249), and Grant [2013]z163 from the Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology. We are grateful to Yaping Yang for statistical advice. This work was supported by the Yat-sen Scholarship of Young Scientist of Sun Yat-sen Memorial Hospital.

Author information

Author notes

  1. Yiwen Lu, Yanbo Chen, and Liling Zhu have contributed equally to this work.

Authors and Affiliations

  1. Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China

    Yiwen Lu MD, Yanbo Chen MD, Liling Zhu MD, Erwei Song MD & Kai Chen MD

  2. Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China

    Yiwen Lu MD, Yanbo Chen MD, Liling Zhu MD, Erwei Song MD & Kai Chen MD

  3. Departments of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Paul Cartwright & Lisa Jacobs MD

Authors
  1. Yiwen Lu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yanbo Chen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liling Zhu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul Cartwright
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erwei Song MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lisa Jacobs MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kai Chen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Erwei Song MD, Lisa Jacobs MD or Kai Chen MD.

Ethics declarations

Disclosure

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplemental Fig. S1

Flow diagram of the selected studies (TIFF 62 kb)

Supplemental Fig. S2

a Forest plot of the local recurrence (LR) rates for overall phyllodes tumors (PTs). The effect size (ES) represented the calculated LR rate of PTs in each study after combining of all studies. b Forest plot of the LR rate for the benign PTs. The ES represented the calculated LR rate for the benign PTs in each study after combining of all studies. c Forest plot of the LR rates for the borderline PTs. The ES represented the estimated LR rate for the borderline PTs. d Forest plot of the LR rates for the malignant PTs. The ES represented the estimated LR rate for the malignant PTs (TIFF 19537 kb)

Supplemental Fig. S3

a Forest plot showing the pooled hazard ratio (HR) of local recurrence (LR) by age (≥ 40 vs. < 40 years). b Forest plot showing the pooled HR of LR by tumor size (> 5 vs. ≤ 5 cm). c Forest plot showing the pooled HR of LR by surgical margin (positive vs. negative). All included studies defined a positive margin as a tumor present on the surgical margin (TIFF 13190 kb)

Supplemental Fig. S4

a Forest plot showing the pooled odds ratios (ORs) of local recurrence (LR) by surgery type (breast-conserving surgery vs. mastectomy) stratified by the phyllodes tumor (PT) grade. b Forest plot showing the pooled ORs of LR by surgical margin (positive vs. negative) stratified by the PT grade. The surgical margin width in each study was marked in the footnote (Fig. 2). The LR rate stratified by surgery (breast-conserving surgery (BCS) vs. mastectomy) and grade reported by Narayanakar et al.16 was conflicting, so the study was not included in this analysis (TIFF 12944 kb)

Supplemental Fig. S5

Forest plot showing the pooled odds ratios (ORs) of local recurrence (LR) by mitoses (≥ 10 vs. < 10/10 HPF), tumor border (infiltrative vs. pushing), stromal cellularity (moderate/severe vs. mild), stromal atypia (severe vs. absent/mild), stromal overgrowth (severe vs. absent/mild), and tumor necrosis (positive vs. negative). #In Spitaleri et al.,20 three events (20 altogether) were not LR. One case had recurrence in the breast and axilla, and two cases had distant metastases (TIFF 12807 kb)

Supplemental Fig. S6

Funnel plot to assess the publication bias of the included studies (TIFF 13893 kb)

Supplemental Fig. S7

a Forest plot of the upgrade rate for benign phyllodes tumors (PTs). b Forest plot of the upgrade rate for borderline PTs. The effect size (ES) represented the calculated upgrade rate of local recurrent PTs in each study after combining of all studies (TIFF 6914 kb)

Supplementary material 8 (DOCX 49 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lu, Y., Chen, Y., Zhu, L. et al. Local Recurrence of Benign, Borderline, and Malignant Phyllodes Tumors of the Breast: A Systematic Review and Meta-analysis. Ann Surg Oncol 26, 1263–1275 (2019). https://doi.org/10.1245/s10434-018-07134-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-07134-5

Search

Navigation