Phyllodes tumor of the breast.
OBJECTIVE
To better identify prognostic factors for local control and survival, as well as the role of different therapeutic options, for phyllodes tumors, a rare fibroepithelial neoplasm of the breast.


METHODS
Data from 443 women treated between 1971 and 2003 were collected from the Rare Cancer Network. The median age was 40 years (range, 12-87 years). Tumors were benign in 284 cases (64%), borderline in 80 cases (18%), and malignant in 79 cases (18%). Surgery consisted of breast-conserving surgery (BCS) in 377 cases (85%) and total mastectomy (TM) in 66 cases (15%). Thirty-nine patients (9%) received adjuvant radiotherapy (RT).


RESULTS
After a median follow-up of 106 months, local recurrence (LR) and distant metastases rates were 19% and 3.4%, respectively. In the malignant and borderline group (n = 159), RT significantly decreased LR (p = 0.02), and TM had better results than BCS (p = 0.0019). Multivariate analysis revealed benign histology, negative margins, and no residual disease (no RD) after initial treatment and RT delivery as independent favorable prognostic factors for local control; benign histology and low number of mitosis for disease-free survival; and pathologic tumor size < or = 3 cm and no tumor necrosis for overall survival. In the malignant and borderline subgroup multivariate analysis TM was the only favorable independent prognostic factor for disease-free survival.


CONCLUSIONS
This study showed that phyllodes tumor patients with no RD after treatment have better local control. Benign tumors have a good prognosis after surgery alone. In borderline and malignant tumors, TM had better results than BCS. Thus, in these forms adjuvant RT should be considered according to histologic criteria.
Belkacémi
Yazid
Y
Centre Oscar Lambret, Lille, France. y-belkacemi@o-lambret.fr
Bousquet
Guilhem
G
Marsiglia
Hugo
H
Ray-Coquard
Isabelle
I
Magné
Nicolas
N
Malard
Yann
Y
Lacroix
Magalie
M
Gutierrez
Cristina
C
Senkus
Elzbieta
E
Christie
David
D
Drumea
Karen
K
Lagneau
Edouard
E
Kadish
Sidney P
SP
Scandolaro
Luciano
L
Azria
David
D
Ozsahin
Mahmut
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D003557:Phyllodes Tumor / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate