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Breast Cancer Research and Treatment

, Volume 171, Issue 2, pp 335–344 | Cite as

Malignant and borderline phyllodes tumors of the breast: a multicenter study of 362 patients (KROG 16-08)

  • Noorie Choi
  • Kyubo Kim
  • Kyung Hwan ShinEmail author
  • Yumi Kim
  • Hyeong-Gon Moon
  • Won ParkEmail author
  • Doo Ho Choi
  • Su Ssan Kim
  • Seung Do Ahn
  • Tae Hyun Kim
  • Mison Chun
  • Yong Bae Kim
  • Suzy Kim
  • Byung Ock Choi
  • Jin Hee Kim
Clinical trial

Abstract

Purpose

To identify risk factors for local recurrence (LR) and investigate roles of adjuvant local therapy for malignant and borderline phyllodes tumors of the breast.

Methods

From 1981 to 2014, 362 patients with malignant (n = 235) and borderline (n = 127) phyllodes tumors were treated by breast-conserving surgery (BCS) or total mastectomy (TM) at 10 centers. Thirty-one patients received adjuvant radiation therapy (RT), and those who received adjuvant chemotherapy were excluded from the study.

Results

Median follow-up was 5 years. LR developed in 60 (16.6%) patients. Regional recurrence occurred in 2 (0.6%) patients and distant metastasis (DM) developed in 19 (5.2%) patients. Patients receiving BCS (p = 0.025) and those not undergoing adjuvant RT (p = 0.041) showed higher LR rates. For malignant subtypes, local control (LC) rates at 5 years for BCS alone, BCS with adjuvant RT, TM alone, and TM with adjuvant RT were 80.7, 93.3, 92.4, and 100%, respectively (p = 0.033). Multivariate analyses revealed BCS alone, tumor size ≥ 5 cm, and positive margins as independent risk factors for LR. Margin-positive BCS alone showed poorest LC regardless of tumor size (62.5%, p = 0.007). For margin-negative BCS alone, 5-year LC rates for tumors ≥ 5 cm versus those < 5 cm were 71.8% versus 89.5% (p = 0.012). For borderline subtypes, only positive margins (p = 0.044) independently increased the risk of LR. DM developed exclusively in malignant subtypes and a prior LR event increased the risk of DM by sixfold (HR 6.2, 95% CI 1.6–16.1, p = 0.001).

Conclusions

Malignant and borderline phyllodes tumors with positive margins after surgery have high LR rates. After treatment by margin-negative BCS alone, patients with large malignant phyllodes tumors ≥ 5 cm also have heightened risk of LR. Thus, such patients should be considered for additional local therapy.

Keywords

Malignant phyllodes tumor Borderline phyllodes tumor Breast neoplasm Adjuvant therapy Recurrence Risk factor 

Notes

Compliance with ethical standards

Conflict of interest

The authors have nothing to disclose.

Ethical standards

Review of medical records was approved by the Korean Radiation Oncology Group (KROG) and the Institutional Review Board of each participating center in accord to the ethical standards of the Helsinki Declaration. Data pertaining to demographic, clinical, pathologic, and follow-up variables were collectively analyzed. Based on the retrospective design of analyses, requirement to obtain written informed consent from patients included in this study was exempted.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Noorie Choi
    • 1
  • Kyubo Kim
    • 2
  • Kyung Hwan Shin
    • 1
    Email author
  • Yumi Kim
    • 3
  • Hyeong-Gon Moon
    • 3
  • Won Park
    • 4
    Email author
  • Doo Ho Choi
    • 4
  • Su Ssan Kim
    • 5
  • Seung Do Ahn
    • 5
  • Tae Hyun Kim
    • 6
  • Mison Chun
    • 7
  • Yong Bae Kim
    • 8
  • Suzy Kim
    • 9
  • Byung Ock Choi
    • 10
  • Jin Hee Kim
    • 11
  1. 1.Department of Radiation OncologySeoul National University College of MedicineSeoulKorea
  2. 2.Department of Radiation OncologyEwha Womans University School of MedicineSeoulKorea
  3. 3.Department of SurgerySeoul National University College of MedicineSeoulKorea
  4. 4.Department of Radiation OncologySamsung Medical Center, Sungkyunkwan University School of MedicineSeoulKorea
  5. 5.Department of Radiation OncologyAsan Medical Center, University of Ulsan College of MedicineSeoulKorea
  6. 6.Proton Therapy CenterResearch Institute and Hospital, National Cancer CenterGoyangKorea
  7. 7.Department of Radiation OncologyAjou University School of MedicineSuwonKorea
  8. 8.Department of Radiation OncologyYonsei Cancer Center, Yonsei University College of MedicineSeoulKorea
  9. 9.Department of Radiation OncologySeoul Metropolitan Government Seoul National University Boramae Medical CenterSeoulKorea
  10. 10.Department of Radiation OncologySeoul St. Mary’s Hospital, The Catholic University of Korea College of MedicineSeoulKorea
  11. 11.Department of Radiation OncologyDongsan Medical Center, Keimyung University School of MedicineDaeguKorea

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