Department of Surgery, Duke University Medical Center, Durham, NC.
Duke Cancer Institute, Duke University, Durham, NC.
J Clin Oncol. 2021 Jan 20;39(3):178-189. doi: 10.1200/JCO.20.02647. Epub 2020 Dec 10.
Phyllodes tumors (PTs) are rare breast neoplasms, which have little granular data on margins. Current guidelines recommend ≥ 1 cm margins; however, recent data suggest narrower margins are sufficient, and for benign PT, a negative margin may not be necessary.
We performed an 11-institution contemporary (2007-2017) review of PT practices. Demographics, surgical, and histopathologic data were captured. Logistic regression was used to estimate the association of select covariates with local recurrence (LR).
Of 550 PT patients, the majority underwent excisional biopsy (55.3%, n = 302/546) or lumpectomy (wide excision) (38.5%, n = 210/546). Median tumor size was 30 mm, 68.9% (n = 379) were benign, 19.6% (n = 108) borderline, and 10.5% (n = 58) malignant. Surgical margins were positive in 42% (n = 231) and negative in 57.3% (n = 311). A second operation was performed in 38.0% (n = 209) of the total cohort, including 51 patients with an initial margin (82.4% with < 2 mm), and 157 with an initial margin, with residual disease only found in six (2.9%). Notably, 32.0% (n = 74) of those with an initial positive margin did undergo a second operation, among whom only 2.7% (n = 2) recurred. Recurrence occurred in 3.3% (n = 18) of the total cohort (n = 15 LR, n = 3 distant), at median follow-up of 36.7 months. LR (all PT grades) was not reduced with wider negative margin width (≥ 2 mm < 2 mm: odds ratio [OR] = 0.39; 95% CI, 0.07 to 2.10; = .27) or final margin status (positive negative: OR = 0.96; 95% CI, 0.26 to 3.52; = .96).
In current practice, many patients are managed outside of current guidelines. For the entire cohort, a wider margin width was not associated with a reduced risk of LR. We do not recommend re-excision of a negative margin for benign PT, regardless of margin width, as a progressively wider surgical margin is unlikely to reduce LR.
叶状肿瘤（PTs）是一种罕见的乳腺肿瘤，其边缘的颗粒状数据很少。目前的指南建议边缘至少 1 厘米；然而，最近的数据表明，更窄的边缘就足够了，对于良性 PT，阴性边缘可能不是必需的。
我们对 11 家机构的当代（2007-2017 年）PT 实践进行了回顾。收集了人口统计学、手术和组织病理学数据。使用逻辑回归估计选择协变量与局部复发（LR）的关联。
在 550 名 PT 患者中，大多数患者接受了切除术（55.3%，n=302/546）或乳房切除术（广泛切除术）（38.5%，n=210/546）。肿瘤大小中位数为 30 毫米，68.9%（n=379）为良性，19.6%（n=108）为交界性，10.5%（n=58）为恶性。42%（n=231）的手术边缘阳性，57.3%（n=311）的手术边缘阴性。总队列中有 38.0%（n=209）的患者进行了第二次手术，其中 51 名患者的初始边缘（82.4%的边缘<2 毫米）为阳性，157 名患者的初始边缘为阳性，仅在 6 名（2.9%）患者中发现残留疾病。值得注意的是，32.0%（n=74）的初始阳性边缘患者进行了第二次手术，其中只有 2.7%（n=2）复发。总队列中有 3.3%（n=18）的患者发生复发（所有 PT 分级），中位随访时间为 36.7 个月。LR（所有 PT 分级）并未因更宽的阴性边缘宽度（≥2 毫米<2 毫米：比值比[OR] = 0.39；95%CI，0.07 至 2.10；=.27）或最终边缘状态（阳性 阴性：OR = 0.96；95%CI，0.26 至 3.52；=.96）而降低。
在当前实践中，许多患者的治疗方法不符合当前指南。对于整个队列，更宽的边缘宽度与 LR 风险降低无关。我们不建议对良性 PT 进行阴性边缘的再次切除，无论边缘宽度如何，因为更宽的手术边缘不太可能降低 LR。
