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Phyllodes Tumor of the Breast: The Challenge Persists

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Abstract

Introduction

Phyllodes tumors of the breast are uncommon, and it is difficult to predict biologic behavior based on clinicopathologic features. Despite the wealth of data on the factors to predict recurrence, little is known about the impact of treatment refinements. This study seeks to define changes in patient characteristics, histopathologic parameters, and outcome between the two periods before and after the care of patients with breast diseases was centralized to a breast specialty.

Methods

The records of 182 patients with phyllodes tumors managed surgically were reviewed. Patients treated from 1985 to 1996 (n = 81) were compared with those seen from 1997 to 2004 (n = 101).

Results

The analysis of the two treatment periods revealed that there was a decrease in tumor size at diagnosis, from 7.7 cm during the earlier period to 4.6 cm during the recent period (P = 0.003). The patients undergoing breast-conserving surgery were significantly increased during the recent period. In contrast, pathologic features and local recurrence rates remained unchanged during the study period. Multivariate analysis revealed that positive surgical margin was the only independent predictor of recurrence, with an increased hazard of 8.0. Overall, upgrading to the next grade was observed in 16% of recurrences.

Conclusions

Breast-conserving surgery with clear margins is the current treatment of choice for phyllodes tumors, but this strategy does not further reduce local recurrence effectively. Optimal management continues to be a challenge.

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Acknowledgments

One of the authors (C.L.L.) was supported by grants from the National Science Council of Taiwan and the Good-Neighbor Medical Research Foundation, Mackay Memorial Hospital, Taipei, Taiwan.

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Authors and Affiliations

  1. Department of Surgery, Mackay Memorial Hospital, 92, Sec 2, Chung-Shan North Road, Taipei, 10449, Taiwan

    Shih-Ping Cheng MD, Yuan-Ching Chang MD, Tsang-Pai Liu MD, Jie-Jen Lee MD, PhD & Chien-Liang Liu MD

  2. Mackay Medicine, Nursing, and Management College, 92, Sheng-Ching Road, Kwan-Tu, Peitou, Taipei, 11260, Taiwan

    Yuan-Ching Chang MD, Tsang-Pai Liu MD & Chien-Liang Liu MD

  3. Graduate Institute of Pharmacology, Taipei Medical University, 250, Wu-Xin Street, Taipei, 11031, Taiwan

    Jie-Jen Lee MD, PhD

  4. Department of Pathology, Mackay Memorial Hospital, 92, Chung-Shan North Road, Taipei, 10449, Taiwan

    Chi-Yuan Tzen MD

Authors
  1. Shih-Ping Cheng MD
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  2. Yuan-Ching Chang MD
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  3. Tsang-Pai Liu MD
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  4. Jie-Jen Lee MD, PhD
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  5. Chi-Yuan Tzen MD
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  6. Chien-Liang Liu MD
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Corresponding author

Correspondence to Chien-Liang Liu MD.

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Cheng, SP., Chang, YC., Liu, TP. et al. Phyllodes Tumor of the Breast: The Challenge Persists. World J. Surg. 30, 1414–1421 (2006). https://doi.org/10.1007/s00268-005-0786-2

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  • DOI: https://doi.org/10.1007/s00268-005-0786-2

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