Division of Mammo-Pelvic Surgery, Department of Gynecology, Obstetrics and Medical Genetics. University Hospital of Lausanne, Av. Pierre-Decker 2, CH-1011, Lausanne, Switzerland.
Division of Mammo-Pelvic Surgery, Department of Gynecology and Obstetrics. Intercantonal Hospital of Broye, Av. de la Colline 3, CH-1530, Payerne, Switzerland.
Breast Cancer Res Treat. 2021 Jan;185(1):21-37. doi: 10.1007/s10549-020-05924-8. Epub 2020 Sep 15.
Phyllodes tumors (PT) of the breast are rare fibroepithelial neoplasms. Information is controversial in the literature regarding to the optimal surgical management. Most studies suggested margins of at least 10 mm while some recent studies suggested narrower margins without an increased risk of local recurrences (LR) and distant metastases (DM). The objective of this systematic review was to identify and compare studies that assessed these different practices.
A systematic review was performed through five databases up to April 2019. Studies exploring the association between the width of margins, subtypes of PT, and the LR and DM rates were considered for inclusion. A statistical model for analyzing sparse data and rare events was used.
Thirteen studies met eligibility criteria and were selected. Considering a threshold of 10 mm (margins < 10 vs margins ≥ 10 mm), the 5-year incidence rate of LR was estimated to be 5.22 vs. 3.63 (diff. -1.59) per 100 person-years for benign PT, 9.60 vs. 7.33 (diff. -2.27) for borderline PT, and 28.58 vs. 21.84 (diff. -6.74) for malignant PT. For DM, it was estimated to be 0.88 vs. 0.86 (diff. -0.02) for benign PT, 1.61 vs. 1.74 (diff. 0.13) for borderline PT, and 4.80 vs 5.18 (diff. 0.38) for malignant PT. The data for a threshold of 1 mm were not sufficient to draw any conclusions.
Irrespective of tumor grade, we found that DM was a rarer event than LR. Malignant PT had the highest incidence rate of LR and DM. This meta-analysis found a clear association between width of margins and LR rates. Whatever the tumor grade, surgical margins ≥ 10 mm guaranteed a lower risk of LR than margins < 10 mm. On the other hand, the width of margin did not influence the apparition of DM.
乳腺叶状肿瘤（PT）是一种罕见的纤维上皮性肿瘤。关于其最佳手术治疗方法，文献中的信息存在争议。大多数研究建议切缘至少为 10mm，而一些最近的研究则建议更窄的切缘，不会增加局部复发（LR）和远处转移（DM）的风险。本系统评价的目的是确定和比较评估这些不同实践的研究。
通过五个数据库进行了系统评价，截止日期为 2019 年 4 月。纳入了研究切缘宽度、PT 亚型与 LR 和 DM 发生率之间关系的研究。使用了一种分析稀疏数据和罕见事件的统计模型。
符合纳入标准的研究有 13 项。考虑到 10mm 的阈值（切缘<10mm 与切缘≥10mm），良性 PT 的 5 年 LR 发生率估计为每 100 人年 5.22 比 3.63（差值-1.59），交界性 PT 为 9.60 比 7.33（差值-2.27），恶性 PT 为 28.58 比 21.84（差值-6.74）。对于 DM，良性 PT 的估计值为 0.88 比 0.86（差值-0.02），交界性 PT 为 1.61 比 1.74（差值 0.13），恶性 PT 为 4.80 比 5.18（差值 0.38）。切缘 1mm 的数据不足以得出任何结论。
无论肿瘤分级如何，我们发现 DM 的发生率均低于 LR。恶性 PT 的 LR 和 DM 发生率最高。本荟萃分析发现切缘宽度与 LR 发生率之间存在明显关联。无论肿瘤分级如何，切缘≥10mm 比切缘<10mm 保证了更低的 LR 风险。另一方面，切缘宽度并不影响 DM 的发生。
