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

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Author(s)
Noorie ChoiKyubo KimKyung Hwan ShinYumi KimHyeong‑Gon MoonWon ParkDoo Ho ChoiSu Ssan KimSeung Do AhnTae Hyun KimMison ChunYong Bae KimSuzy KimByung Ock ChoiJin Hee Kim
Keimyung Author(s)
Kim, Jin Hee
Department
Dept. of Radiation Oncology (방사선종양학)
Journal Title
Breast Cancer Research and Treatment
Issued Date
2018
Volume
171
Issue
2
Keyword
Malignant phyllodes tumorBorderline phyllodes tumorBreast neoplasmAdjuvant therapyRecurrenceRisk factor
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.
Keimyung Author(s)(Kor)
김진희
Publisher
School of Medicine (의과대학)
Citation
Noorie Choi et al. (2018). Malignant and borderline phyllodes tumors of the breast: a multicenter study of 362 patients (KROG 16-08). Breast Cancer Research and Treatment, 171(2), 335–344. doi: 10.1007/s10549-018-4838-3
Type
Article
ISSN
1573-7217
Source
https://link.springer.com/article/10.1007%2Fs10549-018-4838-3
DOI
10.1007/s10549-018-4838-3
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41720
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학)
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