Skip to main content

Advertisement

SpringerLink
Log in

Factors Affecting Local Recurrence for Phyllodes Tumors of the Breast: a Retrospective Analysis of 89 Patients in a Single Center

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

The local recurrence (LR) of phyllodes tumor (PT) of the breast has a clinical importance as it may result in sarcomatous degeneration. The aim of this study was to identify factors affecting LR in patients with PT of the breast. We retrospectively investigated 89 patients with PT who underwent surgical treatment from 2008 to 2014. The predictive role of age, number of tumors, type of surgery, tumor size, tumor histology, stromal cellularity, cellular pleomorphism, stromal overgrowth, mitosis count, resection margin status, and extent of resection margin on LR were analyzed. The median follow-up time was 42 months (range, 10–84 months) and the median patient age was 34 years (range, 15–80 years). The numbers of patients with benign, borderline, and malignant PTs were 68 (76%), 14 (16%), and 7 (8%), respectively. The median tumor size was 3.0 cm (range, 1–13 cm). A total of 85 patients (95%) underwent local or wide excisions while mastectomy was performed in 4 patients (5%). LR occurred in 12 patients (13.5%) and one patient with malignant PT died due to distant metastasis. Positive margin status was the only independent predictor of LR in multivariable model (hazard ratio, 7.5; 95% confidence interval, 3.1–22.5; p = 0.001). Other factors including extent of tumor-free resection margin had not significant effect on LR. Effective local control of disease may be achieved through a negative resection margin. The contribution of wider surgical margins to reduce LR can be questioned by larger studies.

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

Similar content being viewed by others

References

  1. Chaney AW, Pollack A, McNeese MD, Zagars GK, Pisters PW, Pollock RE, Hunt KK (2000) Primary treatment of cystosarcoma phyllodes of the breast. Cancer 89:1502–1511

    Article  CAS  Google Scholar 

  2. Lin CC, Chang HW, Lin CY, Chiu CF, Yeh SP (2013) The clinical features and prognosis of phyllodes tumors: a single institution experience in Taiwan. Int J Clin Oncol 18:614–620. https://doi.org/10.1007/s10147-012-0442-4

    Article  PubMed  Google Scholar 

  3. Briggs RM, Walters M, Rosenthal D (1983) Cystosarcoma phyllodes in adolescent female patients. Am J Surg 146:712–714. https://doi.org/10.1016/0002-9610[83)90324-0

    Article  CAS  PubMed  Google Scholar 

  4. Bellocq JP, Magro G (2003) Fibroepithelial tumors. In: Tavassoeli FA, Devilee P (eds) Pathology and genetics tumours of the breast and female genital organs. IARC Press, Lyon, World Health Organization Classification of Tumors, pp 99–103

    Google Scholar 

  5. Shaaban M, Barthelmes L (2017) Benign phyllodes tumours of the breast: (over) treatment of margins - a literature review. Eur J Surg Oncol 43:1186–1190. https://doi.org/10.1016/j.ejso.2016.10.019

    Article  CAS  PubMed  Google Scholar 

  6. Jang JH, Choi MY, Lee SK et al (2012) Clinicopathologic risk factors for the local recurrence of phyllodes tumors of the breast. Ann Surg Oncol 19:2612–2617. https://doi.org/10.1245/s10434-012-2307-5

    Article  PubMed  Google Scholar 

  7. Barth RJ Jr, Wells WA, Mitchell SE, Cole BF (2009) A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol 16:2288–2294. https://doi.org/10.1245/s10434-009-0489-2

    Article  PubMed  PubMed Central  Google Scholar 

  8. Akcakaya A, Koc B, Erozgen F, Memmi N, Hot S, Yildiz MK, Gucin Z, Adas G, Kemik O (2014) Unpredictable behavior of breast phyllodes tumors. Eur Rev Med Pharmacol Sci 18:2655–2661

    CAS  PubMed  Google Scholar 

  9. Mangi AA, Smith BL, Gadd MA, Tanabe KK, Ott MJ, Souba WW (1999) Surgical management of phyllodes tumors. Arch Surg 134:487–492. https://doi.org/10.1001/archsurg.134.5.487

    Article  CAS  PubMed  Google Scholar 

  10. Karim RZ, Gerega SK, Yang YH, Spillane A, Carmalt H, Scolyer RA, Lee CS (2009) Phyllodes tumours of the breast: a clinicopathological analysis of 65 cases from a single institution. Breast 18:165–170. https://doi.org/10.1016/j.breast.2009.03.001

    Article  CAS  PubMed  Google Scholar 

  11. Badwe RA, Kataria K, Srivastava A (2015) Surgical resection of phyllodes tumour: a radical approach as a safeguard against local recurrence. Indian J Surg 77:161–163. https://doi.org/10.1007/s12262-013-0935-z

  12. Kataria K, Dhar A, Ranjan P, Kumar A, Islam S, Srivastava A (2019) Radical mastectomy SANS axillary lymph node dissection for large phyllodes tumor: a guarantee against recurrence. Indian J Surg https://doi.org/10.1007/s12262-018-1852-y

  13. National Comprehensive Cancer Network (2018) Phyllodes tumors of the breast [version 1.2018). https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 25 July, 2018

  14. Haberer S, Laé M, Seegers V, Pierga JY, Salmon R, Kirova YM, Dendale R, Campana F, Reyal F, Miranda O, Fourquet A, Bollet MA (2009) Management of malignant phyllodes tumors of the breast: the experience of the Institut Curie. Cancer Radiother 13:305–312. https://doi.org/10.1016/j.canrad.2009.05.001

    Article  CAS  PubMed  Google Scholar 

  15. Ganesh V, Drost L, Lee J, Wan BA, Zhang L, Rakovitch E, Vesprini D, Slodkowska E, Zeng KL, Sousa P, Yee C, Lam H, Chow E (2018) A retrospective review of phyllodes tumours of the breast: a single institution experience. Breast 38:52–57. https://doi.org/10.1016/j.breast.2017.12.008

    Article  PubMed  Google Scholar 

  16. Rajan PB, Cranor ML, Rosen PP (1998) Cystosarcoma phyllodes in adolescent girls and young women: a study of 45 patients. Am J Surg Pathol 22:64–69

    Article  CAS  Google Scholar 

  17. Parker SJ, Harries SA (2001) Phyllodes tumours. Postgrad Med J 77:428–435. https://doi.org/10.1136/pmj.77.909.428

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Chen WH, Cheng SP, Tzen CY, Yang TL, Jeng KS, Liu CL, Liu TP (2005) Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol 91:185–194. https://doi.org/10.1002/jso.20334

    Article  PubMed  Google Scholar 

  19. Ben Hassouna J, Damak T, Gamoudi A et al (2006) Phyllodes tumors of the breast: a case series of 106 patients. Am J Surg 192:141–147. https://doi.org/10.1016/j.amjsurg.2006.04.007

    Article  PubMed  Google Scholar 

  20. Komenaka IK, El-Tamer M, Pile-Spellman E, Hibshoosh H (2003) Core needle biopsy as a diagnostic tool to differentiate phyllodes tumor from fibroadenoma. Arch Surg 138:987–990. https://doi.org/10.1001/archsurg.138.9.987

    Article  PubMed  Google Scholar 

  21. Rowell MD, Perry RR, Hsiu JG, Barranco SC (1993) Phyllodes tumors. Am J Surg 165:376–379. https://doi.org/10.1016/S0002-9610[05)80849-9

  22. Co M, Chen C, Tsang JY, Tse G, Kwong A (2018) Mammary phyllodes tumour: a 15-year multicentre clinical review. J Clin Pathol 71:493–497. https://doi.org/10.1136/jclinpath-2017-204827

    Article  PubMed  Google Scholar 

  23. Tremblay-LeMay R, Hogue JC, Provencher L, Poirier B, Poirier É, Laberge S, Diorio C, Desbiens C (2017) How wide should margins be for phyllodes tumors of the breast? Breast J 23:315–322. https://doi.org/10.1111/tbj.12727

    Article  PubMed  Google Scholar 

  24. Spitaleri G, Toesca A, Botteri E et al (2013) Breast phyllodes tumor: a review of literature and a single center retrospective series analysis. Crit Rev Oncol Hematol 88:427–436. https://doi.org/10.1016/j.critrevonc.2013.06.005

    Article  PubMed  Google Scholar 

  25. Abe M, Miyata S, Nishimura S, Iijima K, Makita M, Akiyama F, Iwase T (2011) Malignant transformation of breast fibroadenoma to malignant phyllodes tumor: long-term outcome of 36 malignant phyllodes tumors. Breast Cancer 18:268–272. https://doi.org/10.1007/s12282-009-0185-x

    Article  PubMed  Google Scholar 

  26. Asoglu O, Ugurlu MM, Blanchard K, Grant CS, Reynolds C, Cha SS, Donohue JH (2004) Risk factors for recurrence and death after primary surgical treatment of malignant phyllodes tumors. Ann Surg Oncol 11:1011–1017. https://doi.org/10.1245/ASO.2004.02.001

    Article  PubMed  Google Scholar 

  27. Carter BA, Page DL (2004) Phyllodes tumor of the breast: local recurrence versus metastatic capacity. Hum Pathol 35:1051–1052. https://doi.org/10.1016/j.humpath.2004.08.001

    Article  PubMed  Google Scholar 

  28. Cohn-Cedermark G, Rutqvist LE, Rosendahl I, Silfverswärd C (1991) Prognostic factors in cystosarcoma phyllodes. A clinicopathologic study of 77 patients. Cancer 68:2017–2022. https://doi.org/10.1002/1097-0142[19911101)68:9<2017::AID-CNCR2820680929>3.0.CO;2-V

    Article  CAS  PubMed  Google Scholar 

  29. Tan PH, Thike AA, Tan WJ, Thu MM, Busmanis I, Li H, Chay WY, Tan MH (2012) Predicting clinical behavior of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins. J Clin Pathol 65:69–76. https://doi.org/10.1136/jclinpath-2011-200368

    Article  PubMed  Google Scholar 

  30. Morales-Vásquez F, Gonzalez-Angulo AM, Broglio K, Lopez-Basave HN, Gallardo D, Hortobagyi GN, De La Garza JG (2007) Adjuvant chemotherapy with doxorubicin and dacarbazine has no effect in recurrence-free survival of malignant phyllodes tumors of the breast. Breast J 13:551–556. https://doi.org/10.1111/j.1524-4741.2007.00510.x

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, University of Health Sciences, Ankara Oncology Training and Research Hospital, Kardelen mah. 2040. sok, 2B/27, Yenimahalle, 06370, Ankara, Turkey

    Kaptan Gülben & Uğur Berberoğlu

  2. Department of General Surgery, Erciş State Hospital, Van, Turkey

    Bahadır Öndeş

Authors
  1. Kaptan Gülben
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bahadır Öndeş
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Uğur Berberoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kaptan Gülben.

Ethics declarations

The study was approved by the Institutional Review Board.

Conflict of Interest

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gülben, K., Öndeş, B. & Berberoğlu, U. Factors Affecting Local Recurrence for Phyllodes Tumors of the Breast: a Retrospective Analysis of 89 Patients in a Single Center. Indian J Surg 83 (Suppl 2), 352–358 (2021). https://doi.org/10.1007/s12262-019-02031-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-019-02031-x

Keywords

Search

Navigation