En Bloc Excision of Phyllodes Tumor of the Breast: Radical Approach Heralds Better Outcome |
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| Authors: | Nita S Nair Garvit Chitkara Rohini W Hawaldar Vani Parmar Shalaka Joshi Purvi Thakkar Tanuja Shet Tabbassum Wadasadawala Rajendra A Badwe |
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| Institution: | 1. Department of Surgical Oncology, Breast Disease Management Group, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India;2. Breast Disease Management Group, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India;3. Department of Pathology, Breast Disease Management Group, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India;4. Department of Radiation Oncology, Breast Disease Management Group, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India;1. Postgraduate Program of Tocogynecology, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil;2. Nucleous of Mastology, Barretos Cancer Hospital, Sao Paulo, Brazil;3. Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil;4. Londrina Cancer Hospital, Parana, Brazil;5. Cancer Unit, Santa Casa de Misericórdia de Itapeva, Sao Paulo, Brazil;6. Oswaldo Cruz German Hospital, Sao Paulo, Brazil;7. FACISB School of Medicine, Sao Paulo, Brazil;1. Houston Methodist Cancer Center, Houston, TX;2. Houston Methodist Research Institute, Houston, TX;1. Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy;2. Department of Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy;3. Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy;4. Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy;5. Centre for Translational Genomics and Bioinformatics, IRCCS San Raffaele Scientific Institute, Milan, Italy;6. UOC Oncologia Medica, IRCCS Cà Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy;7. Oncologia Medica e CPDO, ASSL di Olbia-ATS Sardegna, Olbia, Italy;8. SCDU Oncologia, AOU Maggiore della Carità, Novara, Italy;1. Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;2. Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, Shenzhen Center, Shenzhen, China;1. Magee-Womens Research Institute, Pittsburgh, PA;2. Integrative Systems Biology Program, University of Pittsburgh, Pittsburgh, PA;3. UPMC Department of Surgery, Pittsburgh, PA;4. Department of General Surgery, Selçuk University, Konya, Turkey;5. Department of Pathology, Selçuk University, Konya, Turkey;6. Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA;7. Women’s Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA;8. UPMC Hillman Cancer Center, Pittsburgh, PA;9. Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA;10. Institute for Precision Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, PA;1. Faculty of Biotechnology, October University for Modern Sciences and Arts, Giza, Egypt;2. Department of Surgical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt;3. Department of Pathology, Baheya Centre for Early Detection and Treatment of Breast Cancer, Giza, Egypt;4. Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt;5. Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt;6. Breast Surgery Department, Baheya Centre for Early Detection and Treatment of Breast Cancer, Giza, Egypt;7. Center of Material Science Department, Zewail City of Science and Technology, Giza, Egypt;8. Clinical Pathology Department, Baheya Centre for Early Detection and Treatment of Breast Cancer, Giza, Egypt;9. Microbiology Department, College of Medicine, Taif University, Taif, Saudi Arabia;10. Virology Department, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, Egypt |
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| Abstract: | IntroductionSurgery is the primary treatment of phyllodes tumor of the breast, and margins are the most important risk factor associated with local recurrence. We conducted a retrospective audit of 433 patients treated at our center.Patients and MethodsWomen who presented with phyllodes tumors between 1999 and 2017 were included in the analysis. Data was collected from the hospital medical records, telephonic interviews, and electronic mail.ResultsOf the 433 women included in this study, 177 (40.9%) had benign phyllodes tumors, 84 (19.4%) were borderline, 131 (30.3%) were malignant, and 41 (9.5%) had sarcoma. A history of previous excision was noted in 154 (35.6%) patients, of which 104 presented with local recurrence. Of the total patients, 209 (48.3%) underwent breast conservation surgery; the median pT was 6 cm. At a median follow-up of 37.9 months, the 5-year disease-free survival (DFS) was 82.9%. On multivariate analysis, the factors that impacted DFS were histology (hazard ratio, 4.1; 95% confidence interval CI], 1.5-10.9; P = .005) and history of previous excision biopsy (hazard ratio, 3.39; 95% CI, 1.76-6.52; P < .001). We analyzed 231 women who presented without any prior excision separately, wherein at a median follow-up of 44.1 months, the DFS was 92.1% (95% CI, 92.05%-92.15%). In addition, less recurrences were noted in this cohort (5.6% 13/231] in no-excision biopsy vs. 12.5% with surgery done prior to presentation to our institute).ConclusionA previous history of excision and the histologic subtype of phyllodes tumor are factors that have an impact on DFS, thus emphasizing the need for appropriate surgical planning and en bloc excision of the phyllodes at presentation. |
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| Keywords: | Better outcome Phyllodes Radical Surgery Retrospective audit Surgery |
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