Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines.

Autor:	Rosenberger LH; Department of Surgery, Duke University Medical Center, Durham, NC.; Duke Cancer Institute, Duke University, Durham, NC., Thomas SM; Duke Cancer Institute, Duke University, Durham, NC.; Biostatistics and Bioinformatics, Duke University, Durham, NC., Nimbkar SN; Brigham & Women's Hospital, Dana-Farber Cancer Institute, Boston, MA., Hieken TJ; Department of Surgery, Mayo Clinic, Rochester, MN., Ludwig KK; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN., Jacobs LK; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Miller ME; Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH., Gallagher KK; Department of Surgery, University of North Carolina, Chapel Hill, NC., Wong J; Department of Surgery, University of California, San Francisco, San Francisco, CA., Neuman HB; Department of Surgery, University of Wisconsin, Madison, WI., Tseng J; Department of Surgery, University of Chicago Medicine, Chicago, IL., Hassinger TE; Department of Surgery, University of Virginia Health System, Charlottesville, VA., King TA; Brigham & Women's Hospital, Dana-Farber Cancer Institute, Boston, MA., Jakub JW; Department of Surgery, Mayo Clinic, Rochester, MN.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2021 Jan 20; Vol. 39 (3), pp. 178-189. Date of Electronic Publication: 2020 Dec 10.
DOI:	10.1200/JCO.20.02647
Abstrakt:	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.
Databáze:	MEDLINE
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