乳腺良性叶状肿瘤真空辅助旋切与开放手术对术后局部复发的影响

目的探讨真空辅助旋切(VAE)与开放手术对乳腺良性叶状肿瘤术后局部复发的影响。方法回顾性分析广东省妇幼保健院2013年1月至2018年1月收治的128例乳腺良性叶状肿瘤患者的临床资料, 均为女性, 年龄为(37.7±9.1)岁(范围:16～56岁)。80例接受超声引导下VAE(微创组), 48例接受开放手术(开放组)。采用t检验、χ2检验或Fisher确切概率法比较两组患者的临床资料, 采用Logistic回归分析术后局部复发的预后因素。结果微创组肿瘤最大径小于开放组[(20.6±7.4)mm比(42.0±2.0)mm, t=-7.173, P=0.000]。随访时间为(36.4±1.8)个月(范围:12～71个月), 7例发生局部复发, 微创组和开放组局部复发率分别为5.0%(4/80)和6.3%(3/48)。多因素分析结果显示, 肿瘤最大径≥25 mm是术后局部复发的独立预后因素(OR=0.122, 95%CI:0.016～0.901, P=0.039), 手术方式、年龄、绝经状态及同侧乳房曾患纤维腺瘤病史不是术后局部复发的独立预后因素。微创组肿瘤最大径<25 mm和≥25 ...     

良性与交界性叶状肿瘤局部复发风险的分析

目的探讨良性和交界性乳腺叶状肿瘤的复发率以及手术切缘宽度与复发风险的关系。方法回顾性性分析2008年1月至2015年12月在我院行手术切除的良性及交界性叶状肿瘤的患者。收集的数据包括:年龄、原发肿瘤大小、组织分级、手术方式和局部复发情况。结果共入组118名患者,其中为良性81例,交界性37例。患者平均年龄为48.3岁,肿瘤平均大小为4.6cm,平均随访时间3.5年,共有18例患者出现复发,其中良性肿瘤的复发率为13.5%,交界性肿瘤复发率为18%,但缺少足够的数据说明手术切缘多少最合适。结论交界性比良性叶状肿瘤复发率高,但乳腺肿物广泛切除并不能预防非恶性乳腺叶状肿瘤的复发。     

乳腺叶状肿瘤治疗和预后研究

目的 探讨乳腺良性、交界性和恶性叶状肿瘤的外科治疗术式和预后因素。方法 用Logistic回归和Cox模型单因素和多因素分析法对203例乳腺叶状肿瘤的随访结果行统计分析。结果 局部复发和因瘤死亡与组织学等级、局部复发与肿瘤的浸润性生长、因瘤死亡与核分裂和肿瘤性坏死有线性关系。核分裂和肿瘤性坏死是独立的风险因素。良性叶状肿瘤术后局部复发率为21．1％,交界性为45．2％,恶性为64．3％。5年生存率良性叶状肿瘤为100％,交界性为92．0％,恶性为33．3％。结论 对叶状肿瘤不宜采用肿物单纯切除术,良性和交界性应行区段切除术,复发的交界性和恶性应行乳房切除术。     

乳腺恶性叶状肿瘤的研究进展

乳腺叶状肿瘤(PTs)是一种少见的纤维上皮性肿瘤,2012年WHO乳腺肿瘤病理学新分类仍保持对该肿瘤的命名和分类标准,将其分为良性、交界性和恶性[1].叶状肿瘤好发年龄为40 ～ 50岁,恶性叶状肿瘤则较良性者晚2～5年.据美国监测、流行病学与最终结果(SEER)数据库资料显示每年有2.1例/10万女性被诊断为恶性乳腺叶状肿瘤[2].与良性和交界性叶状肿瘤比较,恶性叶状肿瘤更具独特的组织结构和细胞形态,也更具高的复发率及转移率,从而预后不良甚至危及生命.     

广泛切除和局部肿块切除术治疗乳腺分叶状肿瘤的临床效果比较

目的比较广泛肿块切除术与乳腺局部肿块切除术治疗乳腺分叶状肿瘤的临床效果。方法选取2005-08—2010-10间接受治疗的80例乳腺分叶状肿瘤患者,按治疗方法不同,分为广泛肿块切除术组(A组)45例,局部肿块切除术组(B组)35例,分别以患者患侧肢体运动能力、无疾病生存期和中位生存时间等评价指标对2组进行比较分析。结果术后病理均诊断为乳腺分叶状肿瘤,其中良性A组30例(67%),B组23例(66%);交界性A组10例(22%),B组7例(20%);恶性A组5例(11%),B组5例(14%)。术后第12个月B组患者的外展、外旋、摸高高度功能显著优于A组患者(P0.05);而2组患者的肌力、前屈、后伸、内旋功能比较并无显著性差异(P0.05)。术后60个月,A组和B组患者的5 a中位生存时间分别为56个月和55个月(P=0.693);5 a复发率分别为24.14%和44.44%(P=0.061),差异均无统计学意义(P0.05)。A组患者的无疾病生存期为52个月,较B组的47个月显著延长(P=0.025),A组和B组交界性和恶性患者的5 a生存率分别为10.28%和11.17%(P=0.724)。结论广泛肿块切除术较乳腺局部肿块切除术对交界性和恶性乳腺分叶状肿瘤患者的预后更为有利,在患者情况允许的条件下应尽量考虑选择此术式。     

乳腺良性和交界性叶状肿瘤98例临床特征分析

目的 探讨乳腺良性及交界性叶状肿瘤（phyllodes tumor,PT）的临床特点、手术治疗方式和预后。方法 回顾性分析2005-09-01-2015-12-31吉林大学第一医院乳腺外科行手术治疗的67例良性PT和31例交界性PT的临床及病理学资料、手术治疗方案和预后情况。结果 乳腺良性和交界性PT病人的中位年龄分别为43岁和47岁,中位病程分别为4个月和8个月,中位肿瘤直径分别为3 cm和4 cm。粗针穿刺对良性及交界性PT的诊断准确率为38.5%（5/13）,术中快速冰冻病理学检查准确率为47.6%。主要手术方式为乳腺区段切除术和单纯乳房切除术。中位随访时间为35个月。1例交界性PT在术后3年出现局部复发。结论 良性和交界性PT多见于中年女性,非青春期的乳腺巨大肿瘤要考虑PT可能。目前的术前空芯针活检乃至术中快速病理学检查通常难以明确诊断和区分良性和交界性PT,最终的诊断取决于石蜡病理学检查。经外科治疗后,良性和交界性PT的总体预后佳。     

乳腺叶状囊肉瘤24例临床分析

目的探讨乳腺叶状囊肉瘤的临床特点、外科治疗方法及影响预后的因素。方法对24例乳腺叶状囊肉瘤患者采用局部切除11例,单侧乳房切除术10例,乳房切除并腋窝淋巴结清除3例,其中5例(20%)曾诊断为乳腺腺纤维瘤或巨纤维瘤因术后肿瘤复发而经历2~3次局部切除术。结果术后病检证实:低度恶性11例,中度恶性9例,高度恶性4例。随访1~10年(平均5.2年),局部复发率29.1%,5年生存率97%。结论乳腺叶状囊肉瘤发病率低,易误诊;手术切除是其首选的治疗方法,局部切除术后复发应行乳房切除;多数乳腺叶状囊肉瘤恶性程度较低,进展缓慢,预后较好;乳腺叶状囊肉瘤预后与肿瘤的病理类型、肿瘤大小和手术切除是否彻底有关。     

乳腺叶状囊肉瘤24例临床分析

目的探讨乳腺叶状囊肉瘤的临床特点、外科治疗方法及影响预后的因素。方法对我院收治的24例乳腺叶状囊肉瘤患者根据患者年龄、原发肿瘤大小、有无腋淋巴结转移等因素选择局部包块切除术或单乳切除术进行治疗,并对术后治疗结果进行随访。结果本组24例中行局部切除11例,单侧乳房切除术9例,乳房切除并腋窝淋巴结清除4例,其中5例(20％)曾诊断为腺纤维瘤或巨纤维瘤因术后肿瘤复发而经历2-3次局部切除术。术后病理学检查证实:良性11例,交界性9例,恶性4例。随访1-10年(中位5．2年),5年生存率97％,局部复发率31．3％。结论乳腺叶状囊肉瘤发病率低,多数病例病理分化较好,病程进展缓慢,手术切除是其首选的治疗措施,局部切除后反复复发者应行乳房切除;叶状囊肉瘤预后与肿瘤的病理类型、肿瘤大小和手术切除是否彻底有关。     

96例乳腺叶状肿瘤复发转移及预后相关因素分析

目的分析乳腺叶状肿瘤患者的临床病理因素与局部复发、远处转移及预后的关系。方法回顾性分析2011年3月至2018年12月期间重庆医科大学附属第一医院收治的96例乳腺叶状肿瘤患者的临床病理及随访资料,采用χ~2检验及logistic多因素回归分析患者临床病理因素与局部复发和远处转移的关系;运用Kaplan-Meier法计算无病生存率(DFS),采用log-rank检验及Cox比例风险模型分析患者各临床病理因素与预后的关系。结果 96例乳腺叶状肿瘤患者中94例为单侧发病,2例为双侧发病;良性36例,交界性34例,恶性26例。有27例患者术后出现局部复发,4例患者发生远处转移,4例患者死亡,1、3、5年累积DFS分别为81.2%、64.9%、64.9%,5年累积总生存率为92.3%。多因素分析显示,年龄、肿瘤类型和手术方式与局部复发有关(P0.050),未发现各临床病理因素与远处转移有关(P0.050),发现肿瘤类型是影响预后的独立影响因素(P0.050)。结论乳腺叶状肿瘤复发率较高,年龄及肿瘤类型是影响术后局部复发的独立因素,外科手术为主要治疗方式,扩大切除术或乳房全切除术为可供选择的手术方式。     

乳腺分叶状肿瘤14例的诊断和治疗

目的：探讨乳腺分叶状肿瘤的临床病理特点、治疗原则和影响预后的因素。方法：回顾1993年6月至2001年2月收治的14例乳腺分叶状肿瘤患者的临床资料。结果：14例患者平均年龄35岁，按WHO分类标准，其中良性5例，交界性5例，亚性4例。7例行局部切除术，4例行乳腺单纯切除术，3例行乳腺癌改良根治术。随访11例，平均随访时间19个月（6-96个月），1例行乳腺癌改良根治术后2年死于远处转移，3例行局部切除术后复发。结论：保证1-2cm切缘的扩大局部切除术是治疗乳腺分叶状肿瘤的首选方案。     

Management of phyllodes breast tumors

Phyllodes tumors are a rare distinctive fibroepithelial tumors of the breast and their management continues to be questioned. The aim of our study was to examine the treatment and outcome of 165 patients with phyllodes tumors and to review the options for surgical management. This is a retrospective study of 165 patients who presented to the Institut Curie between January 1994 and November 2008 for benign, borderline or malignant phyllodes tumors. The median follow-up was 12.65 months [range 0-149.8]. The median age at diagnosis was 44 years [range 17-79]. One hundred and sixty patients (97%) had breast-conserving treatment, of whom 3 patients (1.8%) had oncoplastic breast surgery. Younger women had a significantly higher chance of having a benign phyllodes tumor (p = 0.0001) or a tumor of small size (p < 0.0001). Histologic examination showed 114 benign (69%), 37 borderline (22%) and 14 malignant tumors (9%). The median tumor size was 30 mm [range 5-150]. The tumor margins were considered incomplete (< 10 mm) in 46 out of 165 cases (28%) with 52% revision surgery. Only the tumor grade was a significant risk factor for incomplete tumor margins (p = 0.005). Fifteen patients developed local recurrence (10%) and two, metastases. In univariate analysis, the histologic grade (p = 0.008), and tumor size (p = 0.02) were significative risk factors for local recurrence with an accentuated risk for "borderline" tumors and tumors of large size.).Similar results were obtained using multivariate analysis (p = 0.07). The mainstay of treatment for phyllodes tumors remains excision with a safe surgical margin, taking advantage breast conserving surgery where amenable. For borderline or malignant phyllodes tumors or in cases of local tumor recurrence, mastectomy, and immediate breast reconstruction may become the preferred option. Genetic analysis will potentially supplement classical histologic examination in order to improve our management of these tumors. The role of adjuvant treatments is unproven and must be considered on a case-by-case basis.     

A Prospective, Multi-Institutional Study of Adjuvant Radiotherapy After Resection of Malignant Phyllodes Tumors

Background  Malignant phyllodes tumors of the breast are unusual neoplasms, with an incidence of approximately 500 cases annually in the United States. Published local recurrence rates after margin-negative breast-conserving resections of borderline malignant and malignant phyllodes tumors are unacceptably high, at 24 and 20%, respectively. It is uncertain whether radiotherapy after resection of phyllodes tumors is beneficial. Methods  We prospectively enrolled patients who were treated with a margin-negative breast-conserving resection of borderline malignant or malignant phyllodes tumors to adjuvant radiotherapy. The primary endpoint was local recurrence. Results  Forty-six women were treated at 30 different institutions. The mean patient age was 49 years (range, 18–76 years). Thirty patients (65%) had malignant phyllodes tumors; the rest were borderline malignant. The mean tumor diameter was 3.7 cm (range, .8–11 cm). Eighteen patients had a negative margin on the first excision. The median size of the negative margin was .35 cm (range, <.1–2 cm). Twenty-eight patients underwent a re-excision because of positive margins in the initial resection. Two patients died of metastatic phyllodes tumor. During a median follow-up of 56 months (range, 12–129 months), none of the 46 patients developed a local recurrence (local recurrence rate, 0%; 95% confidence interval, 0–8). Conclusions  Margin-negative resection combined with adjuvant radiotherapy is very effective therapy for local control of borderline and malignant phyllodes tumors. The local recurrence rate with adjuvant radiotherapy was significantly less than that observed in reported patients treated with margin-negative resection alone.     

Local recurrence after breast‐conserving therapy for phyllodes tumors: A 15‐year retrospective review

There are few data on the long‐term outcomes of patients with phyllodes tumors following breast‐conserving surgery with or without radiation therapy (RT). We reviewed 69 patients diagnosed from 2000 to 2015 with surgical specimens available for central pathology assessment for outcome in relation to histopathologic subtype, margin width, and utilization of RT. Median follow‐up was 63 months (interquartile range, 35‐131 months). Forty‐eight patients had benign, 13 borderline, and eight malignant phyllodes tumors, with local recurrence rates of 4%, 0%, and 38%, respectively (P ≤ .04 comparing malignant lesions to both benign and borderline lesions). None of the eight patients who received RT suffered a local recurrence. Two of the 26 (8%) patients with benign phyllodes tumors who did not receive RT with margins that were positive or <1 mm had local recurrence, compared to none of 18 patients with margins 1 mm or wider who did not receive RT. The one patient with a malignant phyllodes tumor who did not receive RT with margins that were positive or <1 mm did not locally recur, while both patients with margins 10 mm or wider who did not receive RT had local recurrence. One patient with a malignant phyllodes tumor developed distant recurrence following local recurrence. Phyllodes histologic type and margin width were both associated with the risk of local recurrence following breast‐conserving surgery without RT, though the number of events and patients was too small to show these trends were statistically significant.     

Phyllodes tumors of the breast: A clinicopathological study of 118 cases

The clinical and pathological features of phyllodes tumors of the breast were evaluated through a study of 118 cases: 110 benign tumors, four borderline tumors, and four malignant tumors. Local excision was utilized in 105 patients (88%) and radical mastectomy was performed in 10 patients (8%) as the initial treatment. Estrogen receptor (ER) status was positive in seven (50%) of 14 cases and progesterone receptor (PgR) status was positive in nine (75%) of 12 cases. Local recurrence developed in eight patients, six of those having benign tumors, and two having malignant tumors, all of whom were treated by local excision. Of the four patients with malignant tumors, one died of lung and liver metastases 47 months after her first operation. We believe that excision with sufficient free margin may be the treatment of choice for most benign or borderline phyllodes tumors, whereas an Auchincloss modified radical mastectomy or a total glandectomy with lymph node dissection is recommended for patients with malignant tumors. However, a number of problems regarding the treatment of patients with distant metastasis remain yet to be addressed.     

Phyllodes tumours of the breast--a retrospective study from 1982-2000 of 50 cases in Portsmouth

INTRODUCTION: This study is a retrospective analysis of 50 phyllodes tumours to determine the optimal surgical procedure for these types of tumours. We have also reviewed rates of recurrence, metastases and mortality based on choice of procedure and histological type. PATIENTS AND METHODS: Cases were ascertained from pathology databases and clinical details extracted from the hospital records. Fifty patients with phyllodes tumours were identified. These comprised 29 benign, 12 borderline and 9 malignant phyllodes tumours. RESULTS: All benign phyllodes tumours were treated with breast-conserving surgery, these included 16 tumours over 40 mm. Borderline and malignant lesions were treated by breast-conserving surgery or mastectomy. The median follow-up period was 35 months (range, 4-96 months). The recurrence rate for all tumours was 14%. Malignant and borderline phyllodes tumours had a recurrence rate of 28%. Tumours excised with a wide margin did not seem to recur. Breast-conserving surgery appeared to be as effective as mastectomy. The choice of procedure was less important than the width of the excision margin. Recurrence occurred in 1/29 benign tumours. Excision margin width did not influence rate of recurrence. One patient died of metastases after mastectomy. CONCLUSIONS: Breast-conserving surgery is the treatment of choice for all benign lesions. For borderline and malignant lesions, excision with a wide margin reduces the rate of recurrence. If a diagnostic local excision biopsy or enucleation is performed, it should be followed by a definitive wider excision.     

乳腺叶状肿瘤60例临床病理分析

目的探讨乳腺叶状肿瘤的临床病理特征,分析肿瘤复发的相关因素。方法对2006年7月至2012年5月中山大学附属第三医院收治的60例乳腺叶状肿瘤患者的临床病理资料进行回顾性研究。结果良性组较交界性、恶性组平均病程长,发病年龄、肿瘤直径小,肿瘤血流供应少;良性组多呈膨胀性生长,细胞核轻度异型性,核分裂不活跃,肿瘤坏死少见,间质多无过度生长;而交界性、恶性组多呈浸润性生长,核大多有中至重度异型性,分裂活跃,可见肿瘤坏死,间质过度生长。肿瘤复发与病理类型、手术方式、核分裂及间质生长情况相关。结论良性叶状肿瘤比交界性、恶性叶状肿瘤发病早,进展慢,恶性程度低,侵袭性弱;肿瘤复发与肿瘤病理类型、手术方式、核分裂和间质生长情况相关。     

Factors leading to local recurrence or death after surgical resection of phyllodes tumours of the breast

BACKGROUND: Local recurrence and death from metastases are occasional, but consistent, themes in reports of patients with phyllodes tumours. Factors that might contribute to these outcomes were sought. METHODS: Data from 38 patients with a phyllodes breast tumour were reviewed retrospectively, reclassifying the pathological material using the Pietruszka and Barnes criteria. RESULTS: At a median of 12 months, nine patients had developed a local recurrence and four had died from metastases. Following local excision in 24 patients (for diagnosis in 13, for 'fibroadenoma' in nine and for phyllodes tumour in two patients), 13 had no further surgery and five had local recurrence (three of eight benign tumours, two of two malignant tumours). Wide local excision or mastectomy in 18 patients was followed by four recurrences (one of eight borderline tumours, three of ten malignant tumours). All patients with recurrence had margin involvement on histological examination, but not all patients with margin involvement developed recurrence. Lack of statistical correlation between local recurrence and age, delay, size, grade or type of surgery was confounded by selection bias for more extensive surgery for malignant tumours. Death correlated with size (P = 0.05) and grade (P = 0.03) of tumour. CONCLUSION: Inadequate preoperative diagnosis ('fibroadenoma' or failure of triple assessment) frequently led to local excision with positive margins. Without revision this often resulted in local recurrence. Local recurrence of any grade was usually followed by further recurrence. Death was related to tumour size and histological grade, confirming these as prognostic factors.     

Long-term outcomes of malignant phyllodes tumors patients: an institutional experience

BACKGROUND: Malignant phyllodes tumors are an extremely rare breast tumor. Prognostic features and overall survival data have not been consistent across studies. METHODS: Retrospectively, we examined the clinicopathologic features of 27 breast cancer patients treated for malignant phyllodes tumors from 1995 to 2004 and analyzed their recurrence and survival outcomes using contingency tables, a logistic regression model, or a proportional hazard model. RESULTS: The mortality rate was 12% (n = 3) of the cohort and 75% of the group with distant metastases. The median follow-up period was 51 months (range, 12-192 mo). A mitotic index greater than 10 per high-powered field, the presence of stromal overgrowth, mastectomy at initial surgery, and larger tumor size were associated with an increased incidence of distant metastases. Larger tumor size also was associated with an increased incidence of death. CONCLUSIONS: Most patients with malignant phyllodes tumors will enjoy significant long-term survival if treated appropriately with local excision with clear margins.