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Predicting Outcome in Mammary Phyllodes Tumors: Relevance of Clinicopathological Features

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

Abstract

Background

Phyllodes tumors (PTs) of the breast are uncommon fibroepithelial neoplasms. Most behave in a benign fashion but they also have the potential to recur locally or to metastasize.

Methods

In the current study involving 290 PTs (181 benign, 76 borderline, and 33 malignant) from three hospitals over an 11-year period, we assessed the relationship between histologic parameters (including histologic features affecting grade and surgical margin status), postoperative adjuvant treatment, and local recurrences and distant metastases.

Results

An involved surgical margin was the only factor associated with increased risk of local recurrences (hazard ratio [HR] 4.673, p = 0.003), but not for distant metastases. For local recurrences, a wider margin did not confer additional benefits. None of the histologic factors were predictive for local recurrences. In contrast, distant metastases were correlated with histologic parameters, particularly an infiltrative border (HR 10.935, p = 0.012) and the presence of necrosis (HR 15.311, p = 0.007). In this series, all local recurrences were found in patients without radiotherapy, regardless of surgical margin status.

Conclusion

A negative surgical margin is mandatory for the effective local control of PT recurrence, and a minimal margin clearance may be sufficient. For distant metastases, the inherent characteristics of PTs are important, thus it may be prudent to evaluate additional histologic features, including necrosis, for patients’ prognostication.

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Authors and Affiliations

  1. Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong

    Joshua Li, Julia Y. Tsang & Gary M. Tse

  2. Division of Breast Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong

    Clement Chen & Ava Kwong

  3. Department of Pathology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong

    Siu-Ki Chan

  4. Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong

    Sai-Yin Cheung

  5. Department of Pathology, North District Hospital, Sheung Shui, Hong Kong

    Cherry Wu

  6. Department of Pathology, The Second Affiliated Hospital of Jinan University, Shenzhen People’s Hospital, Shenzhen, China

    Jintao Hu

  7. Department of Breast Surgery, The Second Affiliated Hospital of Jinan University, Shenzhen People’s Hospital, Shenzhen, China

    Hong Hu & Dongxian Zhou

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  1. Joshua Li
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  2. Julia Y. Tsang
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Correspondence to Gary M. Tse.

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Disclosures

Joshua Li, Julia Y. Tsang, Clement Chen, Siu-Ki Chan, Sai-Yin Cheung, Cherry Wu, Ava Kwong, Jintao Hu, Hong Hu, Dongxian Zhou, and Gary M. Tse declare no conflicts of interest.

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Li, J., Tsang, J.Y., Chen, C. et al. Predicting Outcome in Mammary Phyllodes Tumors: Relevance of Clinicopathological Features. Ann Surg Oncol 26, 2747–2758 (2019). https://doi.org/10.1245/s10434-019-07445-1

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  • DOI: https://doi.org/10.1245/s10434-019-07445-1

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