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Predicting Outcome in Mammary Phyllodes Tumors: Relevance of Clinicopathological Features

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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.


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.


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.


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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  1. Chaney AW, Pollack A, McNeese MD, et al. Primary treatment of cystosarcoma phyllodes of the breast. Cancer. 2000;89(7):1502–11.

    Article  CAS  PubMed  Google Scholar 

  2. Tan PH, Jayabaskar T, Chuah KL, et al. Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol. 2005;123(4):529–40.

    Article  PubMed  Google Scholar 

  3. 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(1):69–76.

    Article  PubMed  Google Scholar 

  4. Tan PH, Tse GM, Lee A, Simpson JF, Hanby AM. Fibroepithelial tumours. In: Lakhani SR, Ellis IO, Schnitee SJ, Tan PH, van de Vijver MJ (eds). World Health Organisation Classification of Tumors of the Breast. 4th ed. Lyon: IARC Press; 2012. p. 142–7.

    Google Scholar 

  5. Chng TW, Gudi M, Lim SH, Li H, Tan PH. Validation of the Singapore nomogram for outcome prediction in breast phyllodes tumours in a large patient cohort. J Clin Pathol. 2018;71(2):125–8.

    Article  PubMed  Google Scholar 

  6. Chng TW, Lee JY, Lee CS, Li H, Tan MH, Tan PH. Validation of the Singapore nomogram for outcome prediction in breast phyllodes tumours: an Australian cohort. J Clin Pathol. 2016;69(12):1124–6.

    Article  PubMed  Google Scholar 

  7. Nishimura R, Tan PH, Thike AA, et al. Utility of the Singapore nomogram for predicting recurrence-free survival in Japanese women with breast phyllodes tumours. J Clin Pathol. 2014;67(8):748–50.

    Article  PubMed  Google Scholar 

  8. 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(10):2961–70.

    Article  PubMed  Google Scholar 

  9. 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(3):185–94.

    Article  PubMed  Google Scholar 

  10. Taira N, Takabatake D, Aogi K, et al. Phyllodes tumor of the breast: stromal overgrowth and histological classification are useful prognosis-predictive factors for local recurrence in patients with a positive surgical margin. Jpn J Clin Oncol. 2007;37(10):730–6.

    Article  PubMed  Google Scholar 

  11. Yom CK, Han W, Kim SW, Park SY, Park IA, Noh DY. 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(9):2912–8.

    Article  PubMed  Google Scholar 

  12. Koh VCY, Thike AA, Nasir NDM, Yip GWC, Bay BH, Tan PH. Size and heterologous elements predict metastases in malignant phyllodes tumours of the breast. Virchows Arch. 2018;472(4):615–21.

    Article  PubMed  Google Scholar 

  13. 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(10):492–500.

    PubMed  PubMed Central  Google Scholar 

  14. 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(11):1011–7.

    Article  PubMed  Google Scholar 

  15. 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(2):427–36.

    Article  PubMed  Google Scholar 

  16. 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(8):2612–7.

    Article  PubMed  Google Scholar 

  17. Gradishar W, Salerno KE. NCCN Guidelines Update: Breast Cancer. J Natl Compr Canc Netw. 2016;14(5 Suppl):641–4.

    Article  CAS  PubMed  Google Scholar 

  18. Borhani-Khomani K, Talman ML, Kroman N, Tvedskov TF. Risk of local recurrence of benign and borderline phyllodes tumors: a Danish Population-Based Retrospective Study. Ann Surg Oncol. 2016;23(5):1543–8.

    Article  PubMed  Google Scholar 

  19. Kim S, Kim JY, Kim DH, Jung WH, Koo JS. Analysis of phyllodes tumor recurrence according to the histologic grade. Breast Cancer Res Treat. 2013;141(3):353–63.

    Article  PubMed  Google Scholar 

  20. Guillot E, Couturaud B, Reyal F, et al. Management of phyllodes breast tumors. Breast J. 2011;17(2):129–37.

    Article  PubMed  Google Scholar 

  21. Liang MI, Ramaswamy B, Patterson CC, et al. Giant breast tumors: surgical management of phyllodes tumors, potential for reconstructive surgery and a review of literature. World J Surg Oncol. 2008;6:117.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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(3):259–65.

    Article  CAS  PubMed  Google Scholar 

  23. Lin CC, Chang HW, Lin CY, Chiu CF, Yeh SP. The clinical features and prognosis of phyllodes tumors: a single institution experience in Taiwan. Int J Clin Oncol. 2013;18(4):614–20.

    Article  PubMed  Google Scholar 

  24. Tan PH, Jayabaskar T, Yip G, et al. p53 and c-kit (CD117) protein expression as prognostic indicators in breast phyllodes tumors: a tissue microarray study. Mod Pathol. 2005;18(12):1527–34.

    Article  CAS  PubMed  Google Scholar 

  25. Tsang JY, Mendoza P, Putti TC, et al. E-cadherin expression in the epithelial components of mammary phyllodes tumors. Hum Pathol. 2012;43(12):2117–23.

    Article  CAS  PubMed  Google Scholar 

  26. Cohn-Cedermark G, Rutqvist LE, Rosendahl I, Silfversward C. Prognostic factors in cystosarcoma phyllodes. A clinicopathologic study of 77 patients. Cancer. 1991;68(9):2017–22.

    Article  CAS  PubMed  Google Scholar 

  27. Moffat CJ, Pinder SE, Dixon AR, Elston CW, Blamey RW, Ellis IO. Phyllodes tumours of the breast: a clinicopathological review of thirty-two cases. Histopathology. 1995;27(3):205–18.

    Article  CAS  PubMed  Google Scholar 

  28. Tan BY, Acs G, Apple SK, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016;68(1):5–21.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Abdalla HM, Sakr MA. Predictive factors of local recurrence and survival following primary surgical treatment of phyllodes tumors of the breast. J Egypt Natl Canc Inst. 2006;18(2):125–33.

    PubMed  Google Scholar 

  30. Lae M, Gardrat S, Rondeau S, et al. MED12 mutations in breast phyllodes tumors: evidence of temporal tumoral heterogeneity and identification of associated critical signaling pathways. Oncotarget. 2016;7(51):84428–38.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Barth RJ Jr, Wells WA, Mitchell SE, Cole BF. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol. 2009;16(8):2288–94.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Gnerlich JL, Williams RT, Yao K, Jaskowiak N, Kulkarni SA. Utilization of radiotherapy for malignant phyllodes tumors: analysis of the National Cancer Data Base, 1998–2009. Ann Surg Oncol. 2014;21(4):1222–30.

    Article  PubMed  Google Scholar 

  33. Haberer S, Lae M, Seegers V, et al. Management of malignant phyllodes tumors of the breast: the experience of the Institut Curie [in French]. Cancer Radiother. 2009;13(4):305–12.

    Article  CAS  PubMed  Google Scholar 

  34. Pandey M, Mathew A, Kattoor J, et al. Malignant phyllodes tumor. Breast J. 2001;7(6):411–6.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Gary M. Tse.

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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).

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