title: Risk factors for recurrence and death after primary surgical treatment of malignant phyllodes tumors.
abstract: BACKGROUND
  Malignant phyllodes tumor (MPT) is a rare but aggressive breast malignancy. The aim of this study was to evaluate parameters that influence outcome in patients with MPT.
  
  
  METHODS
  Fifty women were diagnosed with MPT of the breast and treated between August 1971 and July 2000. All medical records were reviewed retrospectively. The Cox regression model was used for multivariate analysis.
  
  
  RESULTS
  Tumors were classified as borderline (6%), low grade (32%), or high grade (62%). The median patient age was 46 years (range, 14-77 years). The median tumor diameter was 3.5 cm (range, 1.5-18 cm). Twenty-two patients had wide local excision (WLE), and 28 patients had mastectomy. The median follow-up was 91 months (range, 12-360 months). Local recurrence (LR) occurred in 16 patients (32%) an average of 26 months after surgery (median, 17 months; range, 3-72 months). Distant metastasis occurred in 13 patients (26%) at an average of 53.4 months (median, 36 months; range, 4-177 months). Sixteen (32%) patients have died of their disease. LR was significantly increased with stromal overgrowth (P < .0001), large tumor size (P = .0177), and surgical margins <1 cm (P = .0120), but not with WLE (P = .5099). Stromal overgrowth was the only independent variable predictive of systemic metastasis (P < .0001) and patient survival (P < .0001).
  
  
  CONCLUSIONS
  Stromal overgrowth in MPT carries a grave prognosis. Close surgical margins and large tumor size, but not type of operation, significantly increased LR. Either WLE with adequate margins or mastectomy is an appropriate treatment for patients with MPT.
authors.affiliation: Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. donohue.john@mayo.edu
authors.forename: Oktar
authors.initials: O
authors.lastname: Asoglu
authors.forename: Mustafa M
authors.initials: MM
authors.lastname: Ugurlu
authors.forename: Kay
authors.initials: K
authors.lastname: Blanchard
authors.forename: Clive S
authors.initials: CS
authors.lastname: Grant
authors.forename: Carol
authors.initials: C
authors.lastname: Reynolds
authors.forename: Steven S
authors.initials: SS
authors.lastname: Cha
authors.forename: John H
authors.initials: JH
authors.lastname: Donohue
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D003557:Phyllodes Tumor / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors