title: Breast sarcomas and malignant phyllodes tumours: comparison of clinicopathological features, treatment strategies, prognostic factors and outcomes.
abstract: We aimed to compare the clinicopathological features, treatment strategies and clinical outcomes of breast sarcomas (BS) and malignant phyllodes tumours (MPT), and determine their prognostic factors. Cases of BS and MPT diagnosed at the Department of Pathology, Singapore General Hospital from January 1991 to December 2014 were derived from department files. Clinicopathological features, treatment strategies and survivals of patients with BS and MPT were compared. Prognostic indicators for BS and MPT were identified. BS and MPT were comparable in all except one of their clinicopathological features. A significantly higher proportion of BS patients had a history of previous breast carcinoma and thus radiation to the chest as compared to the MPT group (17.6 vs 0 %, P = 0.018). There was no significant difference in survival outcomes between BS and MPT. The 5-year disease-free survivals (DFS) for BS and MPT were 59.1 and 57.4 % respectively (P = 0.816), while the 5-year overall survivals (OS) for BS and MPT were 86.5 and 78.5 % respectively (P = 0.792). Combining both groups of tumours, univariate analysis showed that DFS was significantly affected by multifocality (P = 0.019), histological subtype (P = 0.014), presence of malignant heterologous elements (P < 0.001) and margin status (P = 0.023). Margin status was the only parameter which had a significant impact on OS (P = 0.040). Multivariate analysis confirmed the above findings. BS and MPT are rare entities with remarkable heterogeneity. They share similar clinicopathological features and outcomes, provoking thoughts on their biological relationship and clinical significance of pathologic distinction.
authors.affiliation: Department of General Surgery, Singapore General Hospital, Singapore, Singapore.
authors.forename: Sue Zann
authors.initials: SZ
authors.lastname: Lim
authors.affiliation: Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Sathiyamoorthy
authors.initials: S
authors.lastname: Selvarajan
authors.affiliation: Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Aye Aye
authors.initials: AA
authors.lastname: Thike
authors.affiliation: Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Nur Diyana Binte Md
authors.initials: ND
authors.lastname: Nasir
authors.affiliation: Singhealth Duke-NUS Breast Centre, Singapore, Singapore.
authors.forename: Benita Kiat Tee
authors.initials: BK
authors.lastname: Tan
authors.affiliation: Singhealth Duke-NUS Breast Centre, Singapore, Singapore.
authors.forename: Kong Wee
authors.initials: KW
authors.lastname: Ong
authors.affiliation: Division of Pathology, Singapore General Hospital, Level 7, Diagnostics Tower, Academia, 20 College Road, Singapore, 169856, Singapore. tan.puay.hoon@sgh.com.sg.
authors.forename: Puay Hoon
authors.initials: PH
authors.lastname: Tan
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D003557:Phyllodes Tumor / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D012509:Sarcoma / Q000473:pathology* / Q000628:therapy; D016019:Survival Analysis
keywords: Angiosarcoma; Clinicopathological parameters; Mesenchymal; Radiation; Recurrence; Survival