放疗及组织学危险因素对恶性叶状肿瘤患者结局的影响。

The Impact of Radiotherapy and Histological Risk Factors on Outcomes in Malignant Phyllodes Tumors.

机构信息

Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.

出版信息

Clin Breast Cancer. 2020 Dec;20(6):e695-e700. doi: 10.1016/j.clbc.2020.05.004. Epub 2020 May 13.

DOI:10.1016/j.clbc.2020.05.004

PMID:32636151

Abstract

PURPOSE

Breast phyllodes tumors (PT) are classified into benign, borderline, and malignant grades based on histopathologic characteristics. Specific to malignant PT (MPT), surgery is the mainstay yet relapse rates are high and knowledge gaps in the literature exist regarding adjuvant radiotherapy (RT). We aimed to investigate the outcomes of patients with MPT treated in a tertiary Asian institution.

METHODS AND MATERIALS

Patients with nonmetastatic MPT treated from February 1992 to June 2019 were analyzed retrospectively. RT details and relapse fields were studied. Outcomes of patients with and without RT were compared and hazard ratios were calculated using Cox proportional hazard test. Multivariable analysis was performed.

RESULTS

Twenty-two of 89 patients received adjuvant RT and the median dose was 60 Gy. In the no-RT group, 4 patients received RT on relapse and had no further recurrences; a further 2 received RT for fungating relapses with good symptomatic relief. RT was only increasingly prescribed after 2004. Median follow-up in the RT group was 3.31 years, compared with 6.17 years in the no-RT group. In the RT group, 15 patients (68.2%) underwent mastectomy, versus 39 (58.2%) in the no-RT group. One patient in the RT group developed an infield local relapse, compared with 21 of 67 patients in the no-RT group. Multivariate model showed that RT decreased risk of locoregional failure (hazard ratio 0.12, 95% confidence interval [CI] 0.02-0.92, P = .04). Three-year locoregional recurrence-free survival was higher in the RT group, 92.3% (95% CI, 78.9-100) versus 73.3% (95% CI, 63.1-85.1) in the no-RT group (P = .03). There were no differences in 3-year survival.

CONCLUSIONS

We recommend that adjuvant radiotherapy be discussed for malignant PT for local control, even after mastectomy.

摘要

目的

乳腺叶状肿瘤（PT）根据组织病理学特征分为良性、交界性和恶性。具体到恶性 PT（MPT），手术是主要治疗方法，但复发率高，且文献中存在辅助放疗（RT）的知识空白。我们旨在调查在一家亚洲三级机构治疗的 MPT 患者的结局。

方法和材料

回顾性分析了 1992 年 2 月至 2019 年 6 月期间治疗的非转移性 MPT 患者。研究了 RT 细节和复发部位。比较了有和无 RT 患者的结局，并使用 Cox 比例风险检验计算了危险比。进行了多变量分析。

结果

89 例患者中 22 例接受了辅助 RT，中位剂量为 60 Gy。在无 RT 组中，4 例患者在复发时接受了 RT，此后未再复发；另有 2 例因溃烂性复发接受 RT，症状得到了很好的缓解。RT 仅在 2004 年后才逐渐开具。在 RT 组中，中位随访时间为 3.31 年，而在无 RT 组中为 6.17 年。在 RT 组中，15 例（68.2%）患者接受了乳房切除术，而无 RT 组中为 39 例（58.2%）。在 RT 组中，1 例患者发生了场内局部复发，而在无 RT 组中，67 例患者中有 21 例发生了局部复发。多变量模型显示，RT 降低了局部区域失败的风险（危险比 0.12，95%置信区间 [CI] 0.02-0.92，P=0.04）。RT 组 3 年局部无复发生存率更高，为 92.3%（95%CI，78.9-100），而无 RT 组为 73.3%（95%CI，63.1-85.1）（P=0.03）。两组 3 年生存率无差异。