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Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines
- Source :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol 39, iss 3, J Clin Oncol
- Publication Year :
- 2021
- Publisher :
- eScholarship, University of California, 2021.
-
Abstract
- PURPOSE Phyllodes tumors (PTs) are rare breast neoplasms, which have little granular data on margins. Current guidelines recommend ≥ 1 cm margins; however, recent data suggest narrower margins are sufficient, and for benign PT, a negative margin may not be necessary. METHODS We performed an 11-institution contemporary (2007-2017) review of PT practices. Demographics, surgical, and histopathologic data were captured. Logistic regression was used to estimate the association of select covariates with local recurrence (LR). RESULTS Of 550 PT patients, the majority underwent excisional biopsy (55.3%, n = 302/546) or lumpectomy (wide excision) (38.5%, n = 210/546). Median tumor size was 30 mm, 68.9% (n = 379) were benign, 19.6% (n = 108) borderline, and 10.5% (n = 58) malignant. Surgical margins were positive in 42% (n = 231) and negative in 57.3% (n = 311). A second operation was performed in 38.0% (n = 209) of the total cohort, including 51 patients with an initial negative margin (82.4% with < 2 mm), and 157 with an initial positive margin, with residual disease only found in six (2.9%). Notably, 32.0% (n = 74) of those with an initial positive margin did not undergo a second operation, among whom only 2.7% (n = 2) recurred. Recurrence occurred in 3.3% (n = 18) of the total cohort (n = 15 LR, n = 3 distant), at median follow-up of 36.7 months. LR (all PT grades) was not reduced with wider negative margin width (≥ 2 mm v < 2 mm: odds ratio [OR] = 0.39; 95% CI, 0.07 to 2.10; P = .27) or final margin status (positive v negative: OR = 0.96; 95% CI, 0.26 to 3.52; P = .96). CONCLUSION In current practice, many patients are managed outside of current guidelines. For the entire cohort, a wider margin width was not associated with a reduced risk of LR. We do not recommend re-excision of a negative margin for benign PT, regardless of margin width, as a progressively wider surgical margin is unlikely to reduce LR.
- Subjects :
- Adult
Cancer Research
medicine.medical_specialty
Neoplasm, Residual
Time Factors
Clinical Decision-Making
Clinical Sciences
Oncology and Carcinogenesis
MEDLINE
Breast Neoplasms
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Margin (machine learning)
Phyllodes Tumor
Risk Factors
Medicine
Humans
Oncology & Carcinogenesis
Mastectomy
Retrospective Studies
Cancer
business.industry
General surgery
Margins of Excision
ORIGINAL REPORTS
Middle Aged
United States
Tumor Burden
Neoplasm Recurrence
Treatment Outcome
Oncology
Local
030220 oncology & carcinogenesis
Residual
Cohort
Practice Guidelines as Topic
Neoplasm
030211 gastroenterology & hepatology
Female
Neoplasm Recurrence, Local
business
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol 39, iss 3, J Clin Oncol
- Accession number :
- edsair.doi.dedup.....4b6882ffb277869d478c06a3156ff600