Department of Surgery, Division of Breast Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
J Clin Pathol. 2018 Jun;71(6):493-497. doi: 10.1136/jclinpath-2017-204827. Epub 2017 Nov 16.
Phyllodes tumour (PT) is an uncommon fibroepithelial tumour of the breast. It has a spectrum of aggressiveness in biological behaviour with chance of local recurrence and, occasionally, metastasis.
A 15-year retrospective review from a multicentre database in Hong Kong was performed.
Clinical and pathological records of 465 patients with 469 PTs between 1998 and 2014 were reviewed. Median age of occurrence was 44 years (range 12-86 years). 281 (59.9%) PTs were benign, 124 (26.4%) were borderline and 64 (13.6%) were malignant. About half of all PTs (239, 51.5%) were between 2 and 5 cm while another 186 (40.1%) were >5 cm in size. Most PT (84.6%) were radiologically benign. Breast-conserving surgery (BCS) was feasible in 384 (82%) patients, whereas 84 (18%) patients had mastectomy. Multivariate analysis found that positive surgical margin (P<0.001) and BCS (P<0.001) were the only significant risk factors for local recurrence, while large tumour size (P=0.008) and malignant PT histotype (P<0.001) were the only significant risk factors for metastasis. Long-term prognosis of benign and borderline PT was excellent. After median follow-up interval of 85 months (range 12-180 months), the disease-specific survival of benign, borderline and malignant PT were 99.6%, 100% and 90.6%, respectively.
Local recurrence of PTs occurs irrespective of the tumour grade. Surgical margin is the only amendable factor to reduce the chance of recurrence.
叶状肿瘤（PT）是一种罕见的乳腺纤维上皮性肿瘤。它在生物学行为上具有一定的侵袭性，有局部复发的可能，偶尔还会发生转移。
对来自香港多中心数据库的 15 年回顾性研究进行了分析。
对 1998 年至 2014 年间的 465 例 469 例 PT 患者的临床和病理记录进行了回顾。发病中位年龄为 44 岁（范围 12-86 岁）。281 例（59.9%）PT 为良性，124 例（26.4%）为交界性，64 例（13.6%）为恶性。所有 PT 中有一半（239 例，51.5%）大小在 2 至 5cm 之间，另外 186 例（40.1%）大小>5cm。大多数 PT（84.6%）影像学上表现为良性。384 例（82%）患者可行保乳手术（BCS），84 例（18%）患者行乳房切除术。多变量分析发现，阳性切缘（P<0.001）和 BCS（P<0.001）是局部复发的唯一显著危险因素，而肿瘤较大（P=0.008）和恶性 PT 组织学类型（P<0.001）是转移的唯一显著危险因素。良性和交界性 PT 的长期预后良好。在中位随访时间 85 个月（范围 12-180 个月）后，良性、交界性和恶性 PT 的疾病特异性生存率分别为 99.6%、100%和 90.6%。
PT 局部复发与肿瘤分级无关。切缘是唯一可降低复发几率的可改变因素。
