Phyllodes tumor of the breast: The challenge persists
Phyllodes tumor of the breast: The challenge persists
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DOI：
10.1007/s00268-005-0786-2
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发表时间：
2006-08-01
影响因子：
2.6
通讯作者：
Liu, Chien-Liang
中科院分区：
文献类型：
--
作者：
Cheng, Shih-Ping;Chang, Yuan-Ching;Liu, Chien-Liang
简介：乳腺叶状瘤并不常见，基于临床病理特征很难预测其生物学行为。尽管关于预测复发的因素有丰富的数据，但对改进治疗的影响知之甚少。本研究旨在确定患者特征、组织病理学参数和结果在乳房疾病患者集中到乳房专科治疗前后的两个时期之间的变化。方法：回顾182例经手术治疗的叶状瘤患者的临床资料。1985年至1996年治疗的患者（n = 81）与1997年至2004年治疗的患者（n = 101）进行比较。结果：两个治疗期的分析显示，诊断时肿瘤大小由早期的7.7 cm减少到近期的4.6 cm （P = 0.003）。近期行保乳手术的患者明显增多。相反，在研究期间，病理特征和局部复发率保持不变。多因素分析显示，手术切缘阳性是复发的唯一独立预测因子，其危险性增加了8.0。总的来说，16%的复发患者升级到下一级。结论：保留乳房边缘清晰的手术是目前叶状肿瘤的治疗选择，但这种策略并不能有效地进一步减少局部复发。优化管理仍然是一个挑战。
Introduction: Phyllodes tumors of the breast are uncommon, and it is difficult to predict biologic behavior based on clinicopathologic features. Despite the wealth of data on the factors to predict recurrence, little is known about the impact of treatment refinements. This study seeks to define changes in patient characteristics, histopathologic parameters, and outcome between the two periods before and after the care of patients with breast diseases was centralized to a breast specialty.Methods: The records of 182 patients with phyllodes tumors managed surgically were reviewed. Patients treated from 1985 to 1996 (n = 81) were compared with those seen from 1997 to 2004 (n = 101).Results: The analysis of the two treatment periods revealed that there was a decrease in tumor size at diagnosis, from 7.7 cm during the earlier period to 4.6 cm during the recent period (P = 0.003). The patients undergoing breast-conserving surgery were significantly increased during the recent period. In contrast, pathologic features and local recurrence rates remained unchanged during the study period. Multivariate analysis revealed that positive surgical margin was the only independent predictor of recurrence, with an increased hazard of 8.0. Overall, upgrading to the next grade was observed in 16% of recurrences.Conclusions: Breast-conserving surgery with clear margins is the current treatment of choice for phyllodes tumors, but this strategy does not further reduce local recurrence effectively. Optimal management continues to be a challenge.