Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
J Natl Compr Canc Netw. 2024 Jul 29;22(7):e247023. doi: 10.6004/jnccn.2024.7023.
Malignant phyllodes tumors (MPTs) are rare breast tumors with high risks of local recurrence and distant metastasis. Surgical intervention is the primary treatment, but the effectiveness of adjuvant therapies is uncertain. This study was designed to analyze the prognostic risk factors associated with MPTs and evaluate the efficacy of postoperative adjuvant chemotherapy.
Patients who were first diagnosed with MPT without distant metastasis and received R0 resection surgery between 1999 and 2023 were included in the present study and stratified into 2 groups: chemotherapy and nonchemotherapy groups. Propensity score matching (PSM) was used to balance baseline characteristics between groups. Kaplan-Meier curves were used to estimate local recurrence-free survival (LRFS) and overall survival (OS). Cox proportional hazards analyses (univariate and multivariate) were conducted to identify prognostic risk factors.
We conducted a study involving 145 patients, 31 of whom underwent a total of 12 different chemotherapy regimens following initial surgical resection. Most patients received chemotherapy regimens primarily consisting of anthracyclines, including anthracycline + ifosfamide (AI) or anthracycline + cyclophosphamide/docetaxel (AC-T) regimens. After a median follow-up of 54.5 months, 37 (25.5%) patients experienced local recurrence and 24 (16.6%) experienced distant metastasis. No significant difference was detected in the rates of local recurrence or distant metastasis between the 2 groups. Axillary lymph node positivity was the only risk factor for LRFS, whereas older age, larger tumors, axillary lymph node positivity, local recurrence, and distant metastasis were significantly associated with worse OS. Chemotherapy did not emerge as a protective factor for LRFS (P=.501) or OS (P=.854). After PSM, patients in the chemotherapy group did not exhibit better 5-year LRFS (P=.934) or 5-year OS (P=.328).
According to our retrospective evaluation, postoperative adjuvant chemotherapy was not associated with improved survival in patients with MPTs without distant metastasis.
恶性叶状肿瘤（MPTs）是一种罕见的乳腺肿瘤，具有较高的局部复发和远处转移风险。手术干预是主要治疗方法，但辅助治疗的效果尚不确定。本研究旨在分析与 MPT 相关的预后危险因素，并评估术后辅助化疗的疗效。
本研究纳入了 1999 年至 2023 年间首次诊断为无远处转移的 MPT 并接受 RO 切除手术的患者，并将其分为化疗组和非化疗组。采用倾向评分匹配（PSM）平衡组间基线特征。采用 Kaplan-Meier 曲线估计局部无复发生存率（LRFS）和总生存率（OS）。采用单因素和多因素 Cox 比例风险分析识别预后危险因素。
我们进行了一项研究，共纳入 145 例患者，其中 31 例患者在初始手术切除后共接受了 12 种不同的化疗方案。大多数患者接受的化疗方案主要包括蒽环类药物，包括蒽环类药物+异环磷酰胺（AI）或蒽环类药物+环磷酰胺/多西他赛（AC-T）方案。中位随访 54.5 个月后，37 例（25.5%）患者发生局部复发，24 例（16.6%）患者发生远处转移。两组间局部复发率或远处转移率无显著差异。腋窝淋巴结阳性是 LRFS 的唯一危险因素，而年龄较大、肿瘤较大、腋窝淋巴结阳性、局部复发和远处转移与 OS 较差显著相关。化疗并未成为 LRFS（P=.501）或 OS（P=.854）的保护因素。PSM 后，化疗组患者的 5 年 LRFS（P=.934）或 5 年 OS（P=.328）均未得到改善。
根据我们的回顾性评估，对于无远处转移的 MPT 患者，术后辅助化疗并不能提高生存率。
