Department of Surgery, McGill University Medical School, Montreal, QC, Canada.
McGill University Medical School, Montreal, QC, Canada.
Ann Surg Oncol. 2023 Mar;30(3):1700-1709. doi: 10.1245/s10434-022-12894-2. Epub 2022 Dec 1.
Phyllodes tumours of the breast are rare fibroepithelial neoplasms with a propensity for recurrence. While surgical excision remains the standard of care, the optimal margin width is an area of active investigation. Recent studies have questioned the necessity for wide, local excision.
We conducted a retrospective, cohort study of patients with phyllodes tumours treated at our institution between 2003 and 2021. Demographic, histopathological, and recurrence data were captured; malignant phyllodes were excluded. Cox proportional hazard models were used to identify covariates associated with local recurrence.
Of 187 patients with phyllodes tumours, 82.9% (n = 155) were classified as benign while 17.1% (n = 32) were borderline. Initial surgical margins were positive in 26.2% (n = 49), < 2 mm in 50.8% (n = 95), and ≥ 2 mm in 23% (n = 43) patients. Among patients with positive margins, 61.2% (n = 30) underwent margin revision. At a median follow-up of 2.9 years, the recurrence rate was 3.7%. On univariate analysis, only a positive margin at the time of initial surgery and not margin width was significantly associated with a higher rate of disease recurrence (hazard ratio [HR] 9.52, 95% confidence interval [CI] 1.85-49.2), as was a size greater than 4 cm on preoperative imaging (HR 10.78, 95% CI 0.97-120.1). Revision of an initially positive margin was not significantly associated with decreased local recurrence (p = 1).
In this large cohort of benign and borderline phyllodes tumours, positive resection margins and not margin width at the initial surgery were associated with a increased recurrence. Individualization of decisions regarding margin reexcision is important.
乳腺叶状肿瘤是一种罕见的纤维上皮性肿瘤，具有复发倾向。虽然外科切除仍然是标准的治疗方法，但最佳的切缘宽度是一个活跃的研究领域。最近的研究质疑广泛局部切除的必要性。
我们对 2003 年至 2021 年在我院治疗的叶状肿瘤患者进行了回顾性队列研究。收集了人口统计学、组织病理学和复发数据；排除了恶性叶状肿瘤。使用 Cox 比例风险模型确定与局部复发相关的协变量。
在 187 例叶状肿瘤患者中，82.9%（n=155）为良性，17.1%（n=32）为交界性。初始手术切缘阳性率为 26.2%（n=49），<2mm 为 50.8%（n=95），≥2mm 为 23%（n=43）。在切缘阳性的患者中，61.2%（n=30）行切缘修正。中位随访 2.9 年后，复发率为 3.7%。单因素分析显示，仅初始手术时切缘阳性而不是切缘宽度与疾病复发率显著相关（风险比[HR]9.52，95%置信区间[CI]1.85-49.2），术前影像学上肿瘤大小大于 4cm 也与疾病复发率显著相关（HR 10.78，95%CI 0.97-120.1）。初次切缘阳性的修正与局部复发率降低无关（p=1）。
在这个大型良性和交界性叶状肿瘤队列中，阳性切缘和初始手术时的切缘宽度与复发增加有关。对于边缘再切除的决策个体化非常重要。
