Ontology type: schema:ScholarlyArticle
2018-09
AUTHORSNoorie Choi, Kyubo Kim, Kyung Hwan Shin, Yumi Kim, Hyeong-Gon Moon, Won Park, Doo Ho Choi, Su Ssan Kim, Seung Do Ahn, Tae Hyun Kim, Mison Chun, Yong Bae Kim, Suzy Kim, Byung Ock Choi, Jin Hee Kim
ABSTRACTPURPOSE: 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. More... »
PAGES335-344
http://scigraph.springernature.com/pub.10.1007/s10549-018-4838-3
DOIhttp://dx.doi.org/10.1007/s10549-018-4838-3
DIMENSIONShttps://app.dimensions.ai/details/publication/pub.1104261779
PUBMEDhttps://www.ncbi.nlm.nih.gov/pubmed/29808288
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"description": "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.\nMETHODS: From 1981 to 2014, 362 patients with malignant (n\u2009=\u2009235) and borderline (n\u2009=\u2009127) 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.\nRESULTS: Median follow-up was 5\u00a0years. LR developed in 60 (16.6%) patients. Regional recurrence occurred in 2 (0.6%) patients\u00a0and distant metastasis\u00a0(DM) developed in 19 (5.2%) patients. Patients receiving BCS (p\u2009=\u20090.025) and those not undergoing adjuvant RT (p\u2009=\u20090.041) 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\u2009=\u20090.033). Multivariate analyses revealed BCS alone, tumor\u2009size\u00a0\u2265\u20095\u00a0cm, and positive margins as independent risk factors for LR. Margin-positive BCS alone showed poorest LC regardless of tumor size (62.5%, p\u2009=\u20090.007). For margin-negative BCS alone, 5-year LC rates for tumors\u2009\u2265\u20095\u00a0cm versus those\u2009<\u20095\u00a0cm were 71.8% versus 89.5% (p\u2009=\u20090.012). For borderline subtypes, only positive margins (p\u2009=\u20090.044) 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\u2009=\u20090.001).\nCONCLUSIONS: 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\u2009\u2265\u20095\u00a0cm also have heightened risk of LR. Thus, such patients should be considered for additional local therapy.",
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