Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Ann Surg Oncol. 2019 May;26(5):1263-1275. doi: 10.1245/s10434-018-07134-5. Epub 2019 Jan 7.
This systematic review and meta-analysis aimed to investigate local recurrence (LR) rates among the three grades (benign, borderline, and malignant) of phyllodes tumors (PTs). The study also assessed various risk factors for LR.
Electronic articles published between 1 January 1995 and 31 May 2018, were searched and critically appraised. The authors independently reviewed the abstracts and extracted data for LR rates and LR risk factors.
The review incorporated 54 studies with 9234 individual cases. The pooled LR rates were 8% for benign, 13% for borderline, and 18% for malignant PTs. The risk of LR was significantly increased by borderline versus benign PTs (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.68-2.38) and malignant versus borderline PTs (OR 1.28; 95% CI 1.05-1.55). The significant risk factors for LR were mitoses, tumor border (infiltrating vs. pushing), stromal cellularity (moderate/severe vs. mild), stromal atypia (severe vs. mild/absent), stromal overgrowth (severe vs. mild/absent), and tumor necrosis (positive vs. negative). Age and tumor size were not associated with LR risk. The subgroup analysis showed that breast-conserving surgery versus mastectomy and positive versus negative surgical margins were significantly associated with an increased LR risk only in malignant PTs.
The risk of LR was significantly increased from benign to borderline to malignant PTs. Mitoses, tumor border, stromal cellularity, stromal atypia, stromal overgrowth, tumor necrosis, type of surgery, and surgical margin status may be risk factors for LR. Different management strategies could be considered for different PT grades.
本系统评价和荟萃分析旨在研究叶状肿瘤（PTs）的三个级别（良性、交界性和恶性）的局部复发（LR）率。该研究还评估了LR 的各种危险因素。
检索了 1995 年 1 月 1 日至 2018 年 5 月 31 日期间发表的电子文章，并进行了批判性评价。作者独立审查了摘要并提取了 LR 率和 LR 危险因素的数据。
该综述纳入了 54 项研究，共涉及 9234 例个体病例。LR 总发生率分别为良性 8%、交界性 13%和恶性 18%。LR 风险显著增加，交界性比良性 PT（优势比 [OR] 2.00；95%置信区间 [CI] 1.68-2.38）和恶性比交界性 PT（OR 1.28；95%CI 1.05-1.55）。LR 的显著危险因素包括有丝分裂、肿瘤边界（浸润性与推进性）、基质细胞密度（中度/重度与轻度）、基质异型性（重度与轻度/缺失）、基质过度生长（重度与轻度/缺失）和肿瘤坏死（阳性与阴性）。年龄和肿瘤大小与 LR 风险无关。亚组分析显示，保乳手术与乳房切除术以及阳性与阴性手术切缘仅与恶性 PT 的 LR 风险增加显著相关。
LR 风险从良性到交界性再到恶性 PT 显著增加。有丝分裂、肿瘤边界、基质细胞密度、基质异型性、基质过度生长、肿瘤坏死、手术类型和手术切缘状态可能是 LR 的危险因素。不同的 PT 分级可以考虑不同的管理策略。
