Abstract
The aim of this study was to explore the independent prognostic factors related to postoperative recurrence‐free survival (RFS) in patients with breast phyllodes tumors (PTBs). A retrospective analysis was conducted in Fudan University Shanghai Cancer Center. According to histological type, patients with benign PTBs were classified as a low‐risk group, while borderline and malignant PTBs were classified as a high‐risk group. The Cox regression model was adopted to identify factors affecting postoperative RFS in the two groups, and a nomogram was generated to predict recurrence‐free survival at 1, 3, and 5 years. Among the 404 patients, 168 (41.6%) patients had benign PTB, 184 (45.5%) had borderline PTB, and 52 (12.9%) had malignant PTB. Fifty‐five patients experienced postoperative local recurrence, including six benign cases, 26 borderline cases, and 22 malignant cases; the three histological types of PTB had local recurrence rates of 3.6%, 14.1%, and 42.3%, respectively. Stromal cell atypia was an independent prognostic factor for RFS in the low‐risk group, while the surgical approach and tumor border were independent prognostic factors for RFS in the high‐risk group, and patients receiving simple excision with an infiltrative tumor border had a higher recurrence rate. A nomogram developed based on clinicopathologic features and surgical approaches could predict recurrence‐free survival at 1, 3, and 5 years. For high‐risk patients, this predictive nomogram based on tumor border, tumor residue, mitotic activity, degree of stromal cell hyperplasia, and atypia can be applied for patient counseling and clinical management. The efficacy of adjuvant radiotherapy remains uncertain.
Highlights
Phyllodes tumor of the breast (PTB) is a rare type of breast tumor comprising fibrous connective tissue and epithelial tissue
The inclusion criteria were (1) patients with primary or recurrent PTB who were admitted to Fudan University Shanghai Cancer Center (FUSCC); if the initial surgery at other hospitals, the initial operation records, and postoperative pathologic examination results should be complete, and the pathological sections from other hospitals should be reviewed by pathologists at FUSCC to confirm the diagnosis, (2) a complete clinical medical history and pathological diagnosis data, especially the initial operation records, (3) the histological type of PTB in accordance with the standards for PTB developed by the World Health Organization (WHO) in 2003 [1], and (4) personal information for the patients
Surgical approach and tumor border were revealed as independent prognostic factors for recurrence-free survival (RFS)
Summary
Phyllodes tumor of the breast (PTB) is a rare type of breast tumor comprising fibrous connective tissue and epithelial tissue. In 2003, the World Health Organization (WHO) recommended naming PTB as phyllodes tumor and divided it into benign, borderline, and malignant types according to five histopathological features: mitotic figures, stromal cell atypia, nature of tumor borders, stromal cell hypercellularity, and overgrowth [1, 2]. PTB can be regarded as a general term of a series of fibrous epithelial tumors with different clinical courses and histopathological features
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