Surgical margins and prognosis of borderline and malignant phyllodes tumors

Jialin Su; Shanling Liu; Gang Tu; Fangxuan Li; Jie Zhang; Lu Gan

doi:10.1007/s12094-023-03377-1

Surgical margins and prognosis of borderline and malignant phyllodes tumors

Clin Transl Oncol. 2024 Jan 13. doi: 10.1007/s12094-023-03377-1. Online ahead of print.

Authors

Jialin Su¹, Shanling Liu², Gang Tu³, Fangxuan Li¹, Jie Zhang¹, Lu Gan⁴

Affiliations

¹ Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
² Department of Clinical Nutrition, Yunan Cancer Hospital, Yunan, People's Republic of China.
³ Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
⁴ Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China. ganlu99@sina.com.

PMID: 38218916
DOI: 10.1007/s12094-023-03377-1

Abstract

Purpose: To investigate the optimal surgical margin and prognostic risk factors for borderline and malignant phyllodes tumors (PTs).

Methods: A retrospective analysis was conducted on patients with borderline and malignant PTs at our hospital from 2011 to 2022. Univariate and multivariate Cox proportional hazard models were employed to analyze the effects of various variables on local recurrence-free survival (LRFS) and disease-free survival (DFS).

Results: This study comprised 150 patients, 85 classified as borderline and 65 as malignant. During a median follow-up of 66 months (range: 3-146 months), 34 cases (22.7%) experienced local recurrence, 9 cases (6.0%) exhibited distant metastasis, and 7 cases (4.7%) resulted in death. Irrespective of the histological subtypes, patients with surgical margins ≥ 1 cm exhibit significantly higher 5-year LRFS and 5-year DFS rates compared to those with margins < 1 cm. Among patients with initial margins < 1 cm, LRFS (P = 0.004) and DFS (P = 0.003) were improved in patients reoperated to achieve margins ≥ 1 cm. Surgical margin < 1 cm (HR = 2.567, 95%CI 1.137-5.793, P = 0.023) and age < 45 years (HR = 2.079, 95%CI 1.033-4.184, P = 0.040) were identified as independent risk factors for LRFS. Additionally, surgical margin < 1 cm (HR = 3.074, 95%CI 1.622-5.826, P = 0.001) and tumor size > 5 cm (HR = 2.719, 95%CI 1.307-5.656, P = 0.007) were determined to be independent risk factors for DFS.

Conclusions: A negative surgical margin of at least 1 cm (with secondary resection if necessary) should be achieved for borderline and malignant PTs. Tumor size > 5 cm and age < 45 years were predictive of recurrence, suggesting multiple therapy modalities may be considered for these high-risk patients.

Keywords: Disease-free survival; Local recurrence-free survival; Phyllodes tumors; Risk factors; Surgical margin.