乳腺叶状肿瘤：辅助放疗再探讨。
Phyllodes tumors of the breast: Adjuvant radiation therapy revisited.
机构信息
Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt.
Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt.
出版信息
Breast. 2021 Aug;58:1-5. doi: 10.1016/j.breast.2021.03.013. Epub 2021 Apr 7.
BACKGROUND
Phyllodes tumors (PT) are rare entity and surgical resection is the cornerstone of treatment. No standard of care exists regarding adjuvant treatment especially radiation therapy (RT).
PATIENTS AND METHODS
We analyzed all patients with non-metastatic, resected phyllodes tumors who presented to our institution from January 2005 through December 2019. Primary study endpoints included local recurrence free survival (LRFS) and overall survival (OS).
RESULTS
One hundred and eight patients were analyzed (patients with incomplete treatment and follow up data were excluded). Fifty patients had benign phyllodes, 26 patients had borderline and 32 patients had malignant phyllodes. In the benign group, no significant difference in LRFS was observed between patients who received adjuvant RT (n = 3) and those who did not (5-year LRFS 100% vs. 85% respectively, p = 0.49). The 5 year OS for patients who received RT was 60% vs. 89% for those who did not (p 0.40). In the borderline/malignant group, adjuvant RT significantly improved five year LRFS (90% in the RT group vs. 42% in the no RT group, p = 0.005). The 5 year LRFS in patients treated with margin negative breast conserving surgery and RT was 100% vs. 34.3% in patients who did not receive RT (p 0.022). Patients treated with mastectomy and RT had a 5 year LRFS of 100% vs. 83% for patients who did not receive RT (p 0.24). On multivariate analysis, radiation therapy was independently associated with decreased hazard of local failure (HR 0.21, CI 0.05-0.89, p = 0.03). No difference in OS was found between the RT and no RT groups (5-year OS was 52% vs. 45% respectively, p 0.54).
CONCLUSION
The results of the current study confirm the excellent prognosis of benign phyllodes tumors; warranting no further adjuvant treatment after margin-negative surgical resection. For patients with borderline/malignant phyllodes tumors, adjuvant radiation therapy significantly improved LRFS after margin negative wide local excision; however, patients treated with mastectomy did not attain the same benefit from adjuvant irradiation.
背景
叶状肿瘤（PT）是一种罕见的实体瘤，手术切除是治疗的基石。关于辅助治疗，特别是放射治疗（RT），尚无标准的治疗方法。
方法
我们分析了 2005 年 1 月至 2019 年 12 月期间在我院就诊的所有非转移性、切除的叶状肿瘤患者。主要研究终点包括局部无复发生存率（LRFS）和总生存率（OS）。
结果
共分析了 108 例患者（排除了治疗和随访数据不完整的患者）。50 例为良性叶状肿瘤，26 例为交界性，32 例为恶性。在良性组中，接受辅助 RT 的患者与未接受 RT 的患者在 LRFS 方面无显著差异（5 年 LRFS 分别为 100%和 85%，p=0.49）。接受 RT 的患者 5 年 OS 为 60%，而未接受 RT 的患者为 89%（p=0.40）。在交界性/恶性组中，辅助 RT 显著提高了 5 年 LRFS（RT 组为 90%，无 RT 组为 42%，p=0.005）。接受边缘阴性保乳手术和 RT 的患者 5 年 LRFS 为 100%，而未接受 RT 的患者为 34.3%（p=0.022）。接受 RT 治疗的乳房切除术患者 5 年 LRFS 为 100%，而未接受 RT 的患者为 83%（p=0.24）。多因素分析显示，放疗与局部复发风险降低独立相关（HR 0.21，CI 0.05-0.89，p=0.03）。RT 组与无 RT 组之间的 OS 无差异（5 年 OS 分别为 52%和 45%，p=0.54）。
结论
本研究结果证实了良性叶状肿瘤的良好预后，在边缘阴性的外科切除后无需进一步辅助治疗。对于交界性/恶性叶状肿瘤患者，边缘阴性广泛切除术后辅助放疗可显著提高 LRFS，但接受乳房切除术的患者并未从辅助放疗中获得相同的获益。
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