Department of Pathology, University of Pittsburgh, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA.
Am J Clin Pathol. 2022 Sep 2;158(3):362-371. doi: 10.1093/ajcp/aqac055.
Phyllodes tumors (PTs) are categorized by the World Health Organization (WHO) as benign, borderline, and malignant. Singapore General Hospital (SGH) nomogram is a recurrence risk assessment tool for PT, which uses cytologic atypia, mitosis, stromal overgrowth, and the surgical margin status. We studied the prognostic significance of WHO classification and its correlation to the SGH nomogram.
We identified 270 consecutive cases of PT (195 benign, 49 borderline, 26 malignant). Follow-up was available on 246 cases (mean follow-up of 51 months).
The recurrence rates were 2% (4 of 176) for benign, 4% (2 of 46) for borderline, and 25% (6 of 24) for malignant (log-rank test P < .0001 for recurrence-free survival). Only five patients with malignant PT experienced distant recurrence. Stromal overgrowth was an independent predictor of recurrence-free survival on multivariable analysis. The mean nomogram scores for benign, borderline, and malignant PT were 20, 20.3, and 32, respectively. The higher than expected score for benign PT was due to positive margins in 39% of cases.
The WHO three-tiered classification of PT is prognostic. Despite positive margin status, most benign PTs do not recur. Other features of the nomogram help in determining recurrence but are also used for WHO classification.
叶状肿瘤（PTs）被世界卫生组织（WHO）分为良性、交界性和恶性。新加坡综合医院（SGH）列线图是一种评估 PT 复发风险的工具，它使用细胞学异型性、有丝分裂、间质过度生长和手术切缘状态。我们研究了 WHO 分类的预后意义及其与 SGH 列线图的相关性。
我们确定了 270 例连续的 PT 病例（195 例良性、49 例交界性、26 例恶性）。246 例可获得随访（平均随访 51 个月）。
良性、交界性和恶性 PT 的复发率分别为 2%（176 例中的 4 例）、4%（46 例中的 2 例）和 25%（24 例中的 6 例）（无复发生存的对数秩检验 P < 0.0001）。仅有 5 例恶性 PT 患者发生远处复发。间质过度生长是多变量分析中无复发生存的独立预测因素。良性、交界性和恶性 PT 的平均列线图评分分别为 20、20.3 和 32。良性 PT 的预期评分较高是由于 39%的病例存在阳性切缘。
PT 的 WHO 三级分类具有预后意义。尽管存在阳性切缘，但大多数良性 PT 不会复发。列线图的其他特征有助于确定复发，但也用于 WHO 分类。
