Predictive factors of local recurrence and survival following primary surgical treatment of phyllodes tumors of the breast.
Predictive factors of local recurrence and survival following primary surgical treatment of phyllodes tumors of the breast.
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发表时间：
2006-06
影响因子：
1.8
通讯作者：
H. Abdalla;M. Sakr
中科院分区：
文献类型：
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作者：
H. Abdalla;M. Sakr
背景与目的叶状肿瘤的特点是易局部复发，偶有转移。局部复发和转移导致的死亡是偶然的，但在叶状肿瘤患者的报告中是一致的。这项研究的目的是确定影响这种罕见肿瘤预后的参数。患者和方法对79例叶状肿瘤患者的资料进行回顾性分析，并根据世界卫生组织(WHO)的标准对病理资料进行重新分类。结果患者年龄16~70岁，中位年龄42岁。肿瘤大小2.5~24 cm，中位数11 cm。按WHO标准，良性肿瘤31例(39.2%)，交界性肿瘤27例(34.2%)，恶性肿瘤21例(26.6%)。中位随访时间为60个月，最长3个月，最长138个月。局部切除后，良性、交界性和恶性肿瘤的局部复发率分别为14.3%、50%和75%，而广泛局部切除后的局部复发率分别为0%、36.3%和40%。而良性、交界性和恶性肿瘤术后局部复发率分别为0%、8.3%和8.3%。局部切除组5年无瘤生存率为63.3%，广泛切除组为70%，乳房切除组为87%(P=0.04)。10例(12.6%)患者在中位病程14个月(范围3-36个月)后发生远处转移。所有糖尿病患者平均5个月后死亡，死亡时间为1~11个月。良性肿瘤、交界性肿瘤和恶性肿瘤的远处转移率分别为3.2%、11.1%和28.6%。良性肿瘤的5年无瘤生存率为90%，交界性肿瘤为69%，恶性肿瘤为61%(p=0.02)。结论叶状瘤的组织类型和切缘是局部复发和远处转移的主要决定因素。在叶状肿瘤的初次外科治疗中，通过广泛的局部切除或乳房切除(如有必要)的完全手术切除是重要的。
BACKGROUND AND PURPOSE The phyllodes tumor is characterized by its tendency to recur locally and occasionally to metastasize. Local recurrence and death from metastases are occasional, but consistent, theme in reports of patients with phyllodes tumors (PTs). The aim of this study was to determine parameters that influence outcome in this uncommon neoplasm. PATIENTS AND METHODS Data from 79 patients with phyllodes tumors were reviewed retrospectively, reclassifying the pathological material using the World Health Organization (WHO) criteria. RESULTS The median age of the patients was 42 years with a range from 16 to 70 years. The tumor size ranged from 2.5 to 24 cm, with a median of 11 cm. Based on the criteria proposed by WHO, 31 cases were benign tumors (39.2%), 27 borderline tumors (34.2%), and 21 malignant tumors (26.6%). The median duration of follow up was 60 months ranging from 3 to 138 months. Following local excision, the local recurrence rates were 14.3%, 50%, and 75% in patients with benign, borderline, and malignant tumors; respectively, while after wide local excision the local recurrence rates were 0%, 36.3% and 40%; respectively. Whereas, 0%, 8.3%, and 8.3% of patients with benign, borderline and malignant tumors; respectively, locally recurred after mastectomy. The 5-year disease free survival was 63.3% after local excision, 70% after wide local excision, and was 87% after mastectomy (p=0.04). Distant metastases (DM) were recorded in 10 patients (12.6%) after a median duration of 14 months (range 3- 36). All cases with DM died after an average of 5 months with a range of 1 to 11 months. Distant metastases developed in 3.2%, 11.1%, and in 28.6% of patients with benign, borderline and malignant tumors; respectively. The 5-year survival with no evidence of disease was 90% for the patients with benign tumors compared to 69% for borderline and 61% for malignant PTs (p= 0.02). CONCLUSIONS The histotype of phyllodes tumors and resection margins were the principal determinants of local recurrence and distant metastases. Complete surgical excision by either wide local excision or mastectomy if necessary is important in the primary surgical treatment of phyllodes tumors.