Abstract
Background
Malignant/borderline phyllodes tumors (PTs) are rare, and little is known about their long-term prognosis. This study sought to evaluate recurrence rates and identify factors associated with local and distant failure.
Methods
From 1957 to 2017, we identified 124 patients with 125 PTs (86 malignant and 39 borderline). Recurrence rates and survival were assessed using the Kaplan–Meier method, and correlated with clinicopathologic factors using the log-rank test.
Results
The median age of the patients was 44 years, and the median tumor size was 5 cm. Breast-conserving surgery was performed for 57% of the patients. At a median follow-up of 7.1 years, 14 patients experienced a locoregional recurrence (LRR), with a 10-year cumulative LRR incidence of 12%. On univariable analysis, age younger than 40 years (p = 0.02) and close/positive margins (p = 0.001) were associated with increased risk of LRR. Seven patients developed distant disease, all occurring in malignant PTs. The 10-year distant recurrence-free survival was 94%. Uniformly poor pathologic features consisting of marked stromal cellularity, stromal overgrowth, infiltrative borders, and 10 or more mitoses per 10 high-power fields (hpf) were identified in 25 PTs (20%), and all distant recurrences occurred in this group. For the patients who did not have uniformly poor features, the 10-year disease-specific survival was 100%, and the overall survival was 94% compared with 66% and 57%, respectively, among those with poor features.
Conclusion
Malignant/borderline PTs without uniformly poor histologic features have an excellent prognosis after surgical resection, with a 10-year disease-specific survival of 100%. The presence of uniformly poor pathologic features predicts a poor prognosis. Efforts should be directed toward new treatment approaches for these tumors.
Similar content being viewed by others
References
Bernstein L, Deapen D, Ross RK. The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer. 1993;71:3020–4.
Macdonald OK, Lee CM, Tward JD, Chappel CD, Gaffney DK. Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the Surveillance, Epidemiology, and End Results (SEER) program. Cancer. 2006;107:2127–33.
National Comprehensive Cancer Network. Phyllodes Tumor. Version 1.2018. Retrieved 20 June 2018 at https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.
Barth RJ Jr, Wells WA, Mitchell SE, Cole BF. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors. Ann Surg Oncol. 2009;16:2288–94.
Gnerlich JL, Williams RT, Yao K, Jaskowiak N, Kulkarni SA. Utilization of radiotherapy for malignant phyllodes tumors: analysis of the National Cancer Data Base, 1998–2009. Ann Surg Oncol. 2014;21:1222–30.
Morales-Vasquez F, Gonzalez-Angulo AM, Broglio K, Lopez-Basave HN, Gallardo D, Hortobagyi GN, De La Garza JG. Adjuvant chemotherapy with doxorubicin and dacarbazine has no effect in recurrence-free survival of malignant phyllodes tumors of the breast. Breast J. 2007;13:551–6.
Abdalla HM, Sakr MA. Predictive factors of local recurrence and survival following primary surgical treatment of phyllodes tumors of the breast. J Egypt Natl Cancer Inst. 2006;18:125–33.
Asoglu O, Ugurlu MM, Blanchard K, Grant CS, Reynolds C, Cha SS, Donohue JH. Risk factors for recurrence and death after primary surgical treatment of malignant phyllodes tumors. Ann Surg Oncol. 2004;11:1011–7.
Barrio AV, Clark BD, Goldberg JI, Hoque LW, Bernik SF, Flynn LW, Susnik B, et al. Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol. 2007;14:2961–70.
Barth RJ Jr. Histologic features predict local recurrence after breast-conserving therapy of phyllodes tumors. Breast Cancer Res Treat. 1999;57:291–5.
Guillot E, Couturaud B, Reyal F, Curnier A, Ravinet J, Lae M, Bollet M, et al. Management of phyllodes breast tumors. Breast J. 2011;17:129–37.
Pezner RD, Schultheiss TE, Paz IB. Malignant phyllodes tumor of the breast: local control rates with surgery alone. Int J Radiat Oncol Biol Phys. 2008;71:710–3.
Reinfuss M, Mitus J, Duda K, Stelmach A, Rys J, Smolak K. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer. 1996;77:910–6.
Onkendi EO, Jimenez RE, Spears GM, Harmsen WS, Ballman KV, Hieken TJ. Surgical treatment of borderline and malignant phyllodes tumors: the effect of the extent of resection and tumor characteristics on patient outcome. Ann Surg Oncol. 2014;21:3304–9.
Yom CK, Han W, Kim SW, Park SY, Park IA, Noh DY. Reappraisal of conventional risk stratification for local recurrence based on clinical outcomes in 285 resected phyllodes tumors of the breast. Ann Surg Oncol. 2015;22:2912–8.
Tan BY, Acs G, Apple SK, Badve S, Bleiweiss IJ, Brogi E, Calvo JP, et al. Phyllodes tumours of the breast: a consensus review. Histopathology. 2016;68:5–21.
Wei J, Tan YT, Cai YC, Yuan ZY, Yang D, Wang SS, Peng RJ, et al. Predictive factors for the local recurrence and distant metastasis of phyllodes tumors of the breast: a retrospective analysis of 192 cases at a single center. Chin J Cancer. 2014;33:492–500.
Belkacemi Y, Bousquet G, Marsiglia H, Ray-Coquard I, Magne N, Malard Y, Lacroix M, et al. Phyllodes tumor of the breast. Int J Radiat Oncol Biol Phys. 2008;70:492–500.
Choi N, Kim K, Shin KH, Kim Y, Moon HG, Park W, Choi DH, et al. Malignant and borderline phyllodes tumors of the breast: a multicenter study of 362 patients (KROG 16-08). Breast Cancer Res Treat. 2018;171:335–44.
Jang JH, Choi MY, Lee SK, Kim S, Kim J, Lee J, Jung SP, et al. Clinicopathologic risk factors for the local recurrence of phyllodes tumors of the breast. Ann Surg Oncol. 2012;19:2612–7.
Tan PH, Thike AA, Tan WJ, Thu MM, Busmanis I, Li H, Chay WY, et al. Predicting clinical behaviour of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins. J Clin Pathol. 2012;65:69–76.
Kim S, Kim JY, Kim DH, Jung WH, Koo JS. Analysis of phyllodes tumor recurrence according to the histologic grade. Breast Cancer Res Treat. 2013;141:353–63.
Moo TA, Alabdulkareem H, Tam A, Fontanet C, Lu Y, Landers A, D’Alfonso T, et al. Association between recurrence and re-excision for close and positive margins versus observation in patients with benign phyllodes tumors. Ann Surg Oncol. 2017;24:3088–92.
Acknowledgment
The preparation of this manuscript was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosure
Dr. Monica Morrow has received speaking honoraria from Roche and Genomic Health, and Dr. Andrea V. Barrio has received speaking honorarium from Roche.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Spanheimer, P.M., Murray, M.P., Zabor, E.C. et al. Long-Term Outcomes After Surgical Treatment of Malignant/Borderline Phyllodes Tumors of the Breast. Ann Surg Oncol 26, 2136–2143 (2019). https://doi.org/10.1245/s10434-019-07210-4
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-019-07210-4