Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
Division of Breast Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong.
Ann Surg Oncol. 2019 Sep;26(9):2747-2758. doi: 10.1245/s10434-019-07445-1. Epub 2019 May 20.
Phyllodes tumors (PTs) of the breast are uncommon fibroepithelial neoplasms. Most behave in a benign fashion but they also have the potential to recur locally or to metastasize.
In the current study involving 290 PTs (181 benign, 76 borderline, and 33 malignant) from three hospitals over an 11-year period, we assessed the relationship between histologic parameters (including histologic features affecting grade and surgical margin status), postoperative adjuvant treatment, and local recurrences and distant metastases.
An involved surgical margin was the only factor associated with increased risk of local recurrences (hazard ratio [HR] 4.673, p = 0.003), but not for distant metastases. For local recurrences, a wider margin did not confer additional benefits. None of the histologic factors were predictive for local recurrences. In contrast, distant metastases were correlated with histologic parameters, particularly an infiltrative border (HR 10.935, p = 0.012) and the presence of necrosis (HR 15.311, p = 0.007). In this series, all local recurrences were found in patients without radiotherapy, regardless of surgical margin status.
A negative surgical margin is mandatory for the effective local control of PT recurrence, and a minimal margin clearance may be sufficient. For distant metastases, the inherent characteristics of PTs are important, thus it may be prudent to evaluate additional histologic features, including necrosis, for patients' prognostication.
乳腺叶状肿瘤（PTs）是一种罕见的纤维上皮性肿瘤。大多数表现为良性行为，但也有局部复发或转移的潜力。
在这项涉及三家医院的 11 年期间的 290 例 PTs（181 例良性、76 例交界性和 33 例恶性）的研究中，我们评估了组织学参数（包括影响分级和手术切缘状态的组织学特征）、术后辅助治疗与局部复发和远处转移的关系。
切缘累及是唯一与局部复发风险增加相关的因素（危险比[HR]4.673，p=0.003），但与远处转移无关。对于局部复发，更宽的切缘并不能带来额外的益处。没有任何组织学因素可预测局部复发。相反，远处转移与组织学参数相关，特别是浸润性边界（HR 10.935，p=0.012）和坏死的存在（HR 15.311，p=0.007）。在本系列中，所有局部复发均发生在未接受放疗的患者中，无论手术切缘状态如何。
阴性手术切缘是有效控制 PT 复发的必要条件，最小的切缘清除可能就足够了。对于远处转移，PTs 的固有特征很重要，因此评估其他组织学特征（包括坏死）以预测患者的预后可能是谨慎的。
