Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Ann Surg Oncol. 2023 Dec;30(13):8344-8352. doi: 10.1245/s10434-023-14128-5. Epub 2023 Aug 28.
Phyllodes tumors (PTs) are rare tumors of the breast. The current National Comprehensive Cancer Network (NCCN) guidelines recommend excision of benign PTs, accepting close or positive margins. Controversy about the optimal treatment for benign PTs remains, especially regarding the preferred margin width after surgical excision and the need for follow-up evaluation.
A nationwide retrospective study analyzed the Dutch population from 1989 to 2022. All patients with a diagnosis of benign PT were identified through a search in the Dutch nationwide pathology databank (Palga). Information on age, year of diagnosis, size of the primary tumor, surgical treatment, surgical margin status, and local recurrence was collected.
The study enrolled 1908 patients with benign PT. The median age at diagnosis was 43 years (interquartile range [IQR], 34-52 years), and the median tumor size was 30 mm (IQR, 19-40 mm). Most of the patients (95%) were treated with breast-conserving surgery (BCS). The overall local recurrence rate was 6.2%, and the median time to local recurrence was 31 months (IQR, 15-61 months). Local recurrence was associated with bilaterality of the tumor (odds ratio [OR], 4.91; 95% confidence interval [CI], 2.95-28.30) and positive margin status (OR, 2.51; 95% CI 1.36-4.63). The local recurrence rate was 8.9% for the patients with positive excision margins and 4.0% for the patients with negative excision margins. Notably, for 27 patients (22.6%) who experienced a local recurrence, histologic upgrading of the recurrent tumor was reported, 7 (5.9%) of whom had recurrence as malignant lesions.
This nationwide series of 1908 patients showed a low local recurrence rate of 6.2% for benign PT, with higher recurrence rates following positive margins.
叶状肿瘤（PTs）是一种罕见的乳腺肿瘤。目前的国家综合癌症网络（NCCN）指南建议切除良性 PTs，接受接近或阳性的边缘。关于良性 PTs 的最佳治疗方法仍存在争议，特别是在手术切除后的最佳边缘宽度以及是否需要随访评估方面。
一项全国性回顾性研究分析了 1989 年至 2022 年期间的荷兰人群。通过在荷兰全国病理学数据库（Palga）中搜索，确定了所有诊断为良性 PTs 的患者。收集了年龄、诊断年份、原发肿瘤大小、手术治疗、手术切缘状态和局部复发的信息。
该研究纳入了 1908 例良性 PTs 患者。诊断时的中位年龄为 43 岁（四分位距 [IQR]，34-52 岁），肿瘤大小的中位数为 30 毫米（IQR，19-40 毫米）。大多数患者（95%）接受了保乳手术（BCS）。总的局部复发率为 6.2%，局部复发的中位时间为 31 个月（IQR，15-61 个月）。局部复发与肿瘤的双侧性（优势比 [OR]，4.91；95%置信区间 [CI]，2.95-28.30）和阳性切缘状态（OR，2.51；95%CI 1.36-4.63）有关。切缘阳性患者的局部复发率为 8.9%，切缘阴性患者的局部复发率为 4.0%。值得注意的是，在 27 例（22.6%）局部复发患者中，报告了复发性肿瘤的组织学升级，其中 7 例（5.9%）为恶性病变复发。
本项纳入 1908 例患者的全国性研究显示，良性 PTs 的局部复发率较低（6.2%），阳性切缘患者的复发率更高。
