Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Surg Oncol. 2012 Aug;19(8):2612-7. doi: 10.1245/s10434-012-2307-5. Epub 2012 Apr 4.
Phyllodes tumors (PTs) are rare breast tumors that usually occur in middle-aged women. Here we discuss our recent experiences in the diagnosis, surgical management, and clinical follow-up of this disease.
We retrospectively reviewed 164 patients with PTs who underwent surgical treatment at the Department of Surgery, Samsung Medical Center, Seoul, Korea, from January 1995 to July 2009. Clinical and histopathological data were analyzed.
The median follow-up period was 33.6 months (range 2-179 months), and the median patient age was 43 years (range of 11-72 years). Tumor size ranged from 1 to 30 cm, with a median of 6.1 cm. A total of 148 patients (90.2 %) received local or wide excisions. Mastectomies were performed in 16 patients (9.8 %). The pathologic diagnoses included 82 benign (50.0 %), 42 borderline (25.6 %), and 40 malignant PTs (24.4 %). The tumor border was infiltrating in 43 patients (26.2 %) and pushing in 116 patients (70.7 %). The resection margin was divided by based on the width. Local recurrence was observed in 31 patients (18.9 %), and distant metastasis developed in four patients with malignant PTs. Risk factors for the local recurrence of a PT were a positive resection margin (P = .029) and tumor size (P = .001).
The presence of tumor cells on the resection margin was a strong prognostic factor for local recurrence of PTs. However, a 1 cm negative margin thickness did not confer any local control advantage over a thinner negative margin width.
叶状肿瘤（PTs）是一种罕见的乳腺肿瘤，通常发生在中年女性中。在这里，我们讨论了我们在诊断、手术治疗和临床随访方面的最新经验。
我们回顾性分析了 1995 年 1 月至 2009 年 7 月在韩国首尔三星医疗中心外科接受手术治疗的 164 例 PTs 患者的临床和组织病理学资料。
中位随访时间为 33.6 个月（范围 2-179 个月），中位患者年龄为 43 岁（范围 11-72 岁）。肿瘤大小为 1-30cm，中位数为 6.1cm。148 例患者（90.2%）接受局部或广泛切除术。16 例患者（9.8%）行乳房切除术。病理诊断包括 82 例良性（50.0%）、42 例交界性（25.6%）和 40 例恶性 PTs（24.4%）。43 例患者（26.2%）肿瘤边界浸润，116 例患者（70.7%）肿瘤边界推移。根据宽度对切除边缘进行分类。31 例患者（18.9%）出现局部复发，4 例恶性 PTs 患者出现远处转移。PT 局部复发的危险因素是切缘阳性（P =.029）和肿瘤大小（P =.001）。
切缘有肿瘤细胞是 PT 局部复发的一个强烈预后因素。然而，1cm 阴性切缘厚度并不比更薄的阴性切缘宽度更能提供局部控制优势。
