Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2024 Nov;31(12):8048-8056. doi: 10.1245/s10434-024-15892-8. Epub 2024 Jul 31.
Optimal surgical margin width for patients with phyllodes tumors (PTs) of the breast remains debated. The aim of this study was to assess the influence of margin width on long-term local recurrence risk.
This was a single-institution retrospective review of patients with confirmed PT treated from 2008-2015. Margins were defined as positive (ink on tumor), narrow (no tumor at inked margin but < 10mm), or widely free (>/= 10mm). LR rates were estimated by the Kaplan-Meier method.
Among 117 female patients, histology included 55 (47%) benign, 29 (25%) borderline, and 33 (28%) malignant PT. Final margins were positive in 16 (14%), narrow in 32 (27%), widely free in 64 (55%), and unknown in 5 (4%) patients. Compared with margins > 10 mm, patients with positive and narrow margins had a higher LR risk [HR 10.57 (95% CI 2.48-45.02) and HR 5.66 (95% CI 1.19-26.99), respectively]. Among benign PTs, the 10-year LR-free rates were 100%, 94%, and 66% for widely negative, narrow, and positive margins, respectively (p = 0.056). For borderline/malignant PT, the 10-year LR-free rates were 93% and 57% for widely negative and narrow margins, respectively (p = 0.02), with no difference in LR between narrow and positive margin groups (p = 1.00).
For benign PTs, a margin of no ink on tumor appears sufficient to optimize local control. In patients with borderline or malignant PTs, achieving a wide surgical margin may remain important as narrower margins were associated with LR rates comparable to those with positive margins.
对于乳腺叶状肿瘤（PT）患者，最佳手术切缘宽度仍存在争议。本研究旨在评估切缘宽度对长期局部复发风险的影响。
这是一项对 2008 年至 2015 年间确诊为 PT 并接受治疗的患者进行的单机构回顾性研究。切缘定义为阳性（肿瘤上有墨水）、狭窄（切缘无肿瘤，但<10mm）或广泛游离（≥10mm）。局部复发率通过 Kaplan-Meier 法估计。
在 117 名女性患者中，组织学包括 55 例（47%）良性、29 例（25%）交界性和 33 例（28%）恶性 PT。16 例（14%）患者的最终切缘阳性，32 例（27%）狭窄，64 例（55%）广泛游离，5 例（4%）患者切缘状态未知。与切缘>10mm相比，阳性和狭窄切缘的患者局部复发风险更高[风险比 10.57（95%置信区间 2.48-45.02）和 HR 5.66（95%置信区间 1.19-26.99）]。在良性 PT 中，广泛阴性、狭窄和阳性切缘的 10 年无局部复发生存率分别为 100%、94%和 66%（p=0.056）。对于交界性/恶性 PT，广泛阴性和狭窄切缘的 10 年无局部复发生存率分别为 93%和 57%（p=0.02），狭窄和阳性切缘组之间的局部复发率无差异（p=1.00）。
对于良性 PT，肿瘤上无墨水切缘似乎足以优化局部控制。对于交界性或恶性 PT 患者，实现广泛的手术切缘可能仍然很重要，因为较窄的切缘与阳性切缘相似的局部复发率相关。
