乳腺叶状肿瘤初次手术治疗后局部复发及生存的预测因素。

Predictive factors of local recurrence and survival following primary surgical treatment of phyllodes tumors of the breast.

作者信息

Abdalla Hassan M, Sakr Mona A

机构信息

The Department of Surgical Oncology, NCI, Cairo University.

出版信息

J Egypt Natl Canc Inst. 2006 Jun;18(2):125-33.

PMID:17496937

Abstract

BACKGROUND AND PURPOSE

The phyllodes tumor is characterized by its tendency to recur locally and occasionally to metastasize. Local recurrence and death from metastases are occasional, but consistent, theme in reports of patients with phyllodes tumors (PTs). The aim of this study was to determine parameters that influence outcome in this uncommon neoplasm.

PATIENTS AND METHODS

Data from 79 patients with phyllodes tumors were reviewed retrospectively, reclassifying the pathological material using the World Health Organization (WHO) criteria.

RESULTS

The median age of the patients was 42 years with a range from 16 to 70 years. The tumor size ranged from 2.5 to 24 cm, with a median of 11 cm. Based on the criteria proposed by WHO, 31 cases were benign tumors (39.2%), 27 borderline tumors (34.2%), and 21 malignant tumors (26.6%). The median duration of follow up was 60 months ranging from 3 to 138 months. Following local excision, the local recurrence rates were 14.3%, 50%, and 75% in patients with benign, borderline, and malignant tumors; respectively, while after wide local excision the local recurrence rates were 0%, 36.3% and 40%; respectively. Whereas, 0%, 8.3%, and 8.3% of patients with benign, borderline and malignant tumors; respectively, locally recurred after mastectomy. The 5-year disease free survival was 63.3% after local excision, 70% after wide local excision, and was 87% after mastectomy (p=0.04). Distant metastases (DM) were recorded in 10 patients (12.6%) after a median duration of 14 months (range 3- 36). All cases with DM died after an average of 5 months with a range of 1 to 11 months. Distant metastases developed in 3.2%, 11.1%, and in 28.6% of patients with benign, borderline and malignant tumors; respectively. The 5-year survival with no evidence of disease was 90% for the patients with benign tumors compared to 69% for borderline and 61% for malignant PTs (p= 0.02).

CONCLUSIONS

The histotype of phyllodes tumors and resection margins were the principal determinants of local recurrence and distant metastases. Complete surgical excision by either wide local excision or mastectomy if necessary is important in the primary surgical treatment of phyllodes tumors.

摘要

背景与目的

叶状肿瘤的特点是易于局部复发，偶尔发生转移。局部复发和转移导致的死亡在叶状肿瘤（PTs）患者的报告中虽不常见，但较为一致。本研究的目的是确定影响这种罕见肿瘤预后的参数。

患者与方法

回顾性分析79例叶状肿瘤患者的数据，使用世界卫生组织（WHO）标准对病理材料进行重新分类。

结果

患者的中位年龄为42岁，范围在16至70岁之间。肿瘤大小在2.5至24厘米之间，中位大小为11厘米。根据WHO提出的标准，31例为良性肿瘤（39.2%），27例为交界性肿瘤（34.2%），21例为恶性肿瘤（26.6%）。中位随访时间为60个月，范围在3至138个月之间。局部切除后，良性、交界性和恶性肿瘤患者的局部复发率分别为14.3%、50%和75%；而广泛局部切除后的局部复发率分别为0%、36.3%和40%。此外，良性、交界性和恶性肿瘤患者接受乳房切除术后的局部复发率分别为0%、8.3%和8.3%。局部切除后5年无病生存率为63.3%，广泛局部切除后为70%，乳房切除术后为87%（p = 0.04）。10例患者（12.6%）出现远处转移（DM），中位发生时间为14个月（范围3至36个月）。所有发生DM的病例平均在5个月后死亡，范围为1至11个月。良性、交界性和恶性肿瘤患者发生远处转移的比例分别为3.2%、11.1%和28.6%。良性肿瘤患者5年无病生存率为90%，交界性肿瘤为69%，恶性PTs为61%（p = 0.02）。