Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study

Neron, Mathias; Sajous, Christophe; Thézenas, Simon; Piperno‐Neumann, Sophie; Reyal, Fabien; Laé, Marick; Chakiba, Camille; Michot, Audrey; Penel, Nicolas; Honoré, Charles; Owen, Cathy; Bertucci, François; Salas, Sébastien; Sâada-Bouzid, Esma; Valentin, Thibaud; Bompas, Emmanuelle; Brahmi, Mehdi; Ray‐Coquard, Isabelle; Blay, Jean‐Yves; Firmin, Nelly

doi:10.1245/s10434-020-08217-y

Cited by 37 publications

(26 citation statements)

References 28 publications

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“…In a similar vein, there is no margin width consensus for MP, 11 and this study suggests that margin status has a little impact on OS. However, this is in contrast to findings from a recent multi‐institutional cohort study, which demonstrated that a 3 mm negative margin was associated with improved OS as compared to a smaller margin width 20 …”

Section: Discussioncontrasting

confidence: 99%

“…In a separate SEER analysis of exclusively MP patients, lymph node evaluation occurred in 20%–30% of patients, with only 1% being positive 23 . A large French multi‐institutional cohort study of MP patients noted receipt of sentinel lymph node biopsy in 7.1% of patients and ALND in 18.6% of patients 20 . Thus, our study and others highlight axillary management as an important opportunity to reduce unnecessary morbidity.…”

Section: Discussionmentioning

confidence: 59%

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Malignant phyllodes tumor and primary breast sarcoma; distinct rare tumors of the breast

Gutnik

Ren

Thomas

et al. 2022

Journal of Surgical Oncology

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Background Malignant phyllodes (MP) and primary breast sarcomas (PBS) are rare neoplasms with overlapping histopathologic features. We compared overall survival (OS) and estimated the association of surgery and therapies with OS. Methods We utilized the National Cancer Database (2004–2016). Patients without surgery, unknown surgery, or margins, or Stage IV disease were excluded. Kaplan–Meier curves and Cox proportional hazards models were used to estimate unadjusted and adjusted OS, respectively. Results A total of 3209 (59.5%) MP, and 2185 (40.5%) PBS were identified. Despite a larger median tumor size in MP (46 vs. 40 mm PBS, p < 0.001), lumpectomy rate was higher for MP (52.9% vs. 27.0% PBS, p < 0.001). Compared to MP, PBS patients more frequently received radiation (28.9% vs. 24%), and chemotherapy (28.1% vs. 4%), both p < 0.001. Unadjusted OS was lower for PBS (57% vs. 85% MP, log‐rank p < 0.001). PBS (vs. MP) had persistently worse survival (hazard ratio [HR]: 1.98, 95% confidence interval [CI]: 1.69–2.31) after adjustment. Receipt of adjuvant therapies was not associated with OS (either neoplasm); however, lumpectomy was associated with improved OS (vs. mastectomy) for both PBS (HR: 0.59, 95% CI: 0.50–0.75) and MP (HR: 0.65, 95% CI: 0.53–0.81). Positive margins had no association with OS for MP (HR: 1.09, 95% CI: 0.75–1.60), but was associated with worse survival for PBS (HR: 2.35, 95% CI: 1.82–3.02). Discussion We found significant survival differences between MP and PBS, with PBS having a consistently worse OS. Our findings support surgery as the mainstay of treatment for both tumor types and suggest that lumpectomy may be a reasonable option for select patients without compromising outcomes.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 59%

Malignant phyllodes tumor and primary breast sarcoma; distinct rare tumors of the breast

Gutnik

Ren

Thomas

et al. 2022

Journal of Surgical Oncology

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“…Re-excision was required for malignant PT to obtain negative margin and reduce LR risk (12,56,57). In this study, mastectomy was found having a positive impact on LR risk than BCS which was probably linked to the surgical procedure indicated by Neron et al, that is, en bloc resection along the muscle fascia (52). Mastectomy should be recommended in the situations where the tumor was too large or if the inability to obtain negative margin to reduce LR risk (7,58).…”

Section: Discussionmentioning

confidence: 66%

“…Some studies also indicated that there was no real advantage to obtain ≥1 cm margins as thinner surgical excisions did not impact LR and the disease-free survival (13,28,35). Neron et al conducted a multicenter nationwide retrospective study of malignant PT and suggested that a 3 mm threshold was sufficient with no impact of wide margins on overall-survival (52). However, the vast majority of studies still recommended WLE with margins ≥1 cm and more studies were needed to identify a precise margin threshold (12,27,(53)(54)(55).…”

Section: Discussionmentioning

confidence: 99%

Surgical management in phyllodes tumors of the breast: a systematic review and meta-analysis

Wei¹,

Yu²,

Ji³

et al. 2022

Gland Surg

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Background: Information is still controversial in the studies regarding the current optimal surgical management of phyllodes tumors (PTs) of the breast. Local recurrence (LR) may occur with an upgraded in the pathological grade, influencing the prognosis of patients with PT. This systematic review and metaanalysis aimed to investigate the association of LR risk with margin status and margin width which could have significant implications on the surgical management of PT.Methods: Independent and comprehensive searches were performed by two authors through five databases including PubMed, Medline, Embase, ScienceDirect and Cochrane Library from January 1990 to October 2021. Studies investigating the association between margin width, margin status and LR rates were considered for inclusion. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Metaanalysis was performed using RevMan5.3 software, and statistical heterogeneity was assessed using the Chisquare test and quantified using the I 2 statistic. Visual inspection of funnel plots was used to judge publication bias.Results: A total of 34 articles were included in this article, all of which with NOS scores above 5.Regardless of the PT grade, positive margin significantly increased the risk of LR [odds ratio (OR) 3.64; 95% confidence interval (CI): 2.60-5.12]. No significant difference was found in the risk of LR between the margins <1 and ≥1 cm (OR 1.39; 95% CI: 0.67-2.92). For benign and borderline PTs, there were no significant differences of the LR risk between breast-conserving surgery (BCS) and mastectomy (benign OR 0.68; 95% CI: 0.12-3.78, borderline OR 1.14; 95% CI: 0.29-4.51). While the LR risk was significantly increased by BCS for malignant PT (OR 2.77; 95% CI: 1.33-5.74).Conclusions: Different surgical management strategies should be considered for different PT grades. BCS was a feasible option and margins <1 cm was not significantly associated with LR risk for all grade of PT.After BCS, benign PT with positive margin could adopt the "wait and watch" strategy with regular followup, while borderline and malignant PTs were expected to underwent re-excision to ensure negative margins.More studies are still needed to clarify and update the existing conclusions and improve the prognosis of PT patients.

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“…Local recurrence of phyllodes tumors has been associated with positive margins, younger age, larger tumor size, and malignant pathologic diagnosis [1,[15][16]. The tumors rarely spread via the lymphatic system and axillary lymph node metastasis rate is < 5%.…”

Section: Discussionmentioning

confidence: 99%

Kiss Flaps to Repair Large Skin Defect After Excision of Giant Malignant Phyllodes Tumor of the Breast: A Case Report and Literature Review

Luo¹,

Zou²,

Hu³

et al. 2021

Preprint

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Background: Malignant phyllodes tumors of the breast are fairly rare and fast-growing tumors. They do not respond to chemotherapy or hormonal therapy except in malignant phyllodes tumors. Therefore, the primary treatment for malignant phyllodes tumors is wide surgical excision. Case presentation: Herein, we report a case study which featured a 26-year-old woman presented with a giant malignant phyllodes tumor measuring 20 × 17 × 13 cm. In order to reduce the chance of local recurrence, treatment for these types of tumors usually involves extensive excision with at least 1 cm of surgical margins. The patient underwent extended lumpectomy with 1-3 cm surgical margins, which left a large skin defect of 25 × 15 cm. Repair of such a large skin defect is a challenge to breast surgeons. This is the first reported case in which a “kiss” flap was successfully used to repair the skin defect created after resection of a giant malignant phyllodes tumor.Conclusions: The kiss flap could be considered as an effective method to repair large chest wall defects after resection of giant phyllodes tumors.

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Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study

Cited by 37 publications

References 28 publications

Malignant phyllodes tumor and primary breast sarcoma; distinct rare tumors of the breast

Malignant phyllodes tumor and primary breast sarcoma; distinct rare tumors of the breast

Surgical management in phyllodes tumors of the breast: a systematic review and meta-analysis

Kiss Flaps to Repair Large Skin Defect After Excision of Giant Malignant Phyllodes Tumor of the Breast: A Case Report and Literature Review

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