Department of Surgical Oncology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland; Department of Anatomy, Collegium Medicum, Jagiellonian University, ul. Kopernika 12, 31-034 Cracow, Poland.
Department of Gynecological Oncology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, ul. Garncarska 11, 31-115 Cracow, Poland.
Breast. 2019 Feb;43:85-90. doi: 10.1016/j.breast.2018.11.009. Epub 2018 Nov 26.
The primary treatment of choice for patients with phyllodes tumor of the breast (PTB) is surgery. Two major problems regarding the treatment of such patients remain unclear: what is the appropriate surgical margin and what role is played by adjuvant radiotherapy (ART).
The study provides a retrospective review of all patients with PTB treated between 1952 and 2013 at a single institute. The histology slides were re-examined based on WHO criteria. The clinical characteristics and therapy outcomes were obtained. The five-year survival with no evidence of disease (NED) was used as the end point.
The study population comprised 340 women with PTB. Fifty-five percent of the patients were diagnosed with the benign, 11.8% with borderline and 33.2% with malignant PTB. All the patients received primary treatment with surgery (mastectomy-27.1%, and BCS- 72.9%). Local recurrence (LR) was found in 28 (9.1%) of these patients. Four patients with borderline and 8 with malignant PTB who were treated with BCS and had tumor-free margins < 1 cm received ART. None of these patients had LR and all survived 5 years NED. Of the 340 patients from our group, 294 (86.4%) survived five-years NED.
The prognosis for benign PTB is excellent and can be cured with surgery alone. A sufficient margin would be 0.1 cm (data from the literature) or 0.2-0.4 cm (our study). We recommend application of ART for such patients but the role of ART in patients with borderline and malignant PTB treated with BCS and with surgical margin < 1 cm remains uncertain.
乳腺叶状肿瘤（PTB）患者的主要治疗选择是手术。目前仍有两个关于此类患者治疗的主要问题尚未明确：适当的手术切缘是多少，以及辅助放疗（ART）的作用是什么。
本研究对单机构 1952 年至 2013 年间治疗的所有 PTB 患者进行了回顾性分析。根据世界卫生组织（WHO）标准重新检查组织学切片。获得了临床特征和治疗结果。无疾病证据（NED）的 5 年生存率被用作终点。
本研究人群包括 340 名患有 PTB 的女性。55%的患者被诊断为良性，11.8%为交界性，33.2%为恶性 PTB。所有患者均接受了以手术为主的初始治疗（乳房切除术-27.1%，保乳术-72.9%）。这些患者中有 28 人（9.1%）出现局部复发（LR）。4 名交界性和 8 名恶性 PTB 患者接受了保乳术且肿瘤切缘无肿瘤<1cm，接受了 ART。这些患者均未出现 LR，且均在 5 年内 NED 存活。在我们的研究组中，340 名患者中有 294 名（86.4%）在 5 年内 NED 存活。
良性 PTB 的预后极好，单独手术即可治愈。足够的切缘应为 0.1cm（来自文献数据）或 0.2-0.4cm（我们的研究）。我们建议对这些患者应用 ART，但在接受保乳术且切缘<1cm 的交界性和恶性 PTB 患者中，ART 的作用尚不确定。
