Changchit Nattakarn, Laokulrath Natthawadee, Rushatamukayanunt Pradit, Pisarnturakit Pongthep
Division of Head Neck and Breast Surgery Department of Surgery Siriraj Hospital, Bangkok, Thailand.
Department of Pathology Siriraj Hospital, Bangkok, Thailand.
Breast J. 2024 Aug 2;2024:1432313. doi: 10.1155/2024/1432313. eCollection 2024.
Phyllodes tumors (PTs) are fibroepithelial neoplasms of the breast, with current treatment guidelines recommending wide excision to achieve surgical margins of ≥1 cm to minimize the recurrence risk. However, diagnostic challenges with core biopsy specimens often result in suboptimal surgical margins. This study aims to elucidate the correlation between margin status and PT recurrence, thereby informing surgical decision-making and enhancing patient outcomes.
This single-center, retrospective study reviewed records of Thai women diagnosed with PTs between 2011 and 2018, collecting data on demographics, clinical presentation, surgical approach, tumor grade, size, and margin status. The primary endpoint was recurrence.
Among 165 PT cases analyzed-49.1% borderline, 38.2% benign, and 12.7% malignant-the overall recurrence rate was 13.9% ( = 23) over a median follow-up of 4.5 years. No significant difference in recurrence rates was observed between patients with negative resection margins <1 cm (ranging from <1 mm to 9 mm) compared to those with ≥1 cm (10.2% vs. 7.1%, =1.00). Notably, in negative resection margins <1 cm group, a margin <1 mm (close margin) was associated with a significantly higher recurrence rate compared to margins of 1-9 mm (17.0% vs. 4.9%, =0.04). Borderline PTs followed the overall trend, while benign PTs showed increased recurrence with positive margins. Multivariate analysis indicated a significant association between margins <1 mm and recurrence (adjusted HR = 10.78 (95% CI 1.32-88.07), =0.027), highlighting an increased recurrence risk with more extensive positive margins.
Our findings suggest that a wide surgical margin of ≥1 centimeter may not be necessary to prevent recurrence in benign and borderline PTs. Notably, surgical margins narrower than 1 millimeter substantially elevate the recurrence likelihood in cases of borderline PTs. Furthermore, the presence of positive surgical margins correlates with an increased recurrence rate in benign PTs. These findings highlight the critical need for a strategic approach in determining surgical margins, tailored specifically to the type of PT, to enhance patient outcomes effectively.
叶状肿瘤（PTs）是乳腺的纤维上皮性肿瘤，目前的治疗指南建议进行广泛切除，以获得≥1厘米的手术切缘，从而将复发风险降至最低。然而，核心活检标本的诊断挑战常常导致手术切缘不理想。本研究旨在阐明切缘状态与PT复发之间的相关性，从而为手术决策提供依据并改善患者预后。
这项单中心回顾性研究回顾了2011年至2018年间被诊断为PTs的泰国女性的记录，收集了有关人口统计学、临床表现、手术方式、肿瘤分级、大小和切缘状态的数据。主要终点是复发。
在分析的165例PT病例中——49.1%为交界性、38.2%为良性、12.7%为恶性——在中位随访4.5年期间，总体复发率为13.9%（n = 23）。切除切缘<1厘米（范围从<1毫米到9毫米）的患者与切缘≥1厘米的患者相比，复发率无显著差异（10.2%对7.1%，p = 1.00）。值得注意的是，在切除切缘<1厘米的组中，切缘<1毫米（切缘接近）与1 - 9毫米切缘相比，复发率显著更高（17.0%对4.9%，p = 0.04）。交界性PTs遵循总体趋势，而良性PTs切缘阳性时复发增加。多因素分析表明切缘<1毫米与复发之间存在显著关联（调整后HR = 10.78（95%CI 1.32 - 88.07），p = 0.027），突出显示切缘阳性范围越广复发风险越高。
我们的研究结果表明，对于良性和交界性PTs，可能无需≥1厘米的宽手术切缘来预防复发。值得注意的是，对于交界性PTs病例，小于1毫米的手术切缘会显著提高复发可能性。此外，手术切缘阳性与良性PTs的复发率增加相关。这些发现凸显了在确定手术切缘时采取针对性策略的迫切需求，该策略应根据PT类型进行专门定制，以有效改善患者预后。
