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Malignant and borderline phyllodes tumors of the breast: a multicenter study of 362 patients (KROG 16-08)

Title
Malignant and borderline phyllodes tumors of the breast: a multicenter study of 362 patients (KROG 16-08)
Authors
Choi N.Kim K.Shin K.H.Kim Y.Moon H.-G.Park W.Choi D.H.Kim S.S.Ahn S.D.Kim T.H.Chun M.Kim Y.B.Kim S.Choi B.O.Kim J.H.
Ewha Authors
김규보
SCOPUS Author ID
김규보scopus
Issue Date
2018
Journal Title
Breast Cancer Research and Treatment
ISSN
0167-6806JCR Link
Citation
vol. 171, no. 2, pp. 335 - 344
Keywords
Adjuvant therapyBorderline phyllodes tumorBreast neoplasmMalignant phyllodes tumorRecurrenceRisk factor
Publisher
Springer New York LLC
Indexed
SCI; SCIE; SCOPUS scopus
Abstract
Purpose: To identify risk factors for local recurrence (LR) and investigate roles of adjuvant local therapy for malignant and borderline phyllodes tumors of the breast. Methods: From 1981 to 2014, 362 patients with malignant (n = 235) and borderline (n = 127) phyllodes tumors were treated by breast-conserving surgery (BCS) or total mastectomy (TM) at 10 centers. Thirty-one patients received adjuvant radiation therapy (RT), and those who received adjuvant chemotherapy were excluded from the study. Results: Median follow-up was 5 years. LR developed in 60 (16.6%) patients. Regional recurrence occurred in 2 (0.6%) patients and distant metastasis (DM) developed in 19 (5.2%) patients. Patients receiving BCS (p = 0.025) and those not undergoing adjuvant RT (p = 0.041) showed higher LR rates. For malignant subtypes, local control (LC) rates at 5 years for BCS alone, BCS with adjuvant RT, TM alone, and TM with adjuvant RT were 80.7, 93.3, 92.4, and 100%, respectively (p = 0.033). Multivariate analyses revealed BCS alone, tumor size ≥ 5 cm, and positive margins as independent risk factors for LR. Margin-positive BCS alone showed poorest LC regardless of tumor size (62.5%, p = 0.007). For margin-negative BCS alone, 5-year LC rates for tumors ≥ 5 cm versus those < 5 cm were 71.8% versus 89.5% (p = 0.012). For borderline subtypes, only positive margins (p = 0.044) independently increased the risk of LR. DM developed exclusively in malignant subtypes and a prior LR event increased the risk of DM by sixfold (HR 6.2, 95% CI 1.6–16.1, p = 0.001). Conclusions: Malignant and borderline phyllodes tumors with positive margins after surgery have high LR rates. After treatment by margin-negative BCS alone, patients with large malignant phyllodes tumors ≥ 5 cm also have heightened risk of LR. Thus, such patients should be considered for additional local therapy. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
DOI
10.1007/s10549-018-4838-3
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의과대학 > 의학과 > Journal papers
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