Impact of Metastasis Surgery and Alkylating-Agent-Based Chemotherapy on Outcomes of Metastatic Malignant Phyllodes Tumors: A Multicenter Retrospective Study

Autor: Jean-Yves Blay, Charles Honoré, Marick Laé, Audrey Monneur, Mehdi Brahmi, Fabien Reyal, Nicolas Isambert, Camille Chakiba, Esma Saada-Bouzid, Sophie Piperno-Neumann, Thomas Ryckewaert, Nelly Firmin, S. Thezenas, Christophe Sajous, Nicolas Penel, Sébastien Salas, Mathias Neron, Isabelle Ray-Coquard, François Bertucci, Florence Duffaud
Přispěvatelé: Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Unité de biostatistiques, CRLCC Val d'Aurelle - Paul Lamarque, Institut Curie [Paris], Département de recherche translationnelle, Département d'oncologie médicale, Institut Bergonié [Bordeaux], UNICANCER-UNICANCER, Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université Lille Nord de France (COMUE)-UNICANCER, Institut Gustave Roussy (IGR), Pôle chirurgical et interventionnel [Gustave Roussy], Centre de Recherche en Cancérologie de Marseille (CRCM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Aix Marseille Université (AMU), Medical Oncology Unit, S. Camillo-Forlanini Hospital, Service d’Oncologie Médicale [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE)-Assistance Publique - Hôpitaux de Marseille (APHM), Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Département d'oncologie médicale [Centre Georges-François Leclerc], Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), Centre Léon Bérard [Lyon], Service d'Oncologie Médicale, Département d'oncologie Médicale, Département de Recherche Translationnelle, Université de Lille-UNICANCER, Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE)
Rok vydání: 2019
Předmět:
Zdroj: Annals of Surgical Oncology
Annals of Surgical Oncology, Springer Verlag, 2019, ⟨10.1245/s10434-019-08097-x⟩
Annals of Surgical Oncology, 2019, ⟨10.1245/s10434-019-08097-x⟩
ISSN: 1534-4681
1068-9265
DOI: 10.1245/s10434-019-08097-x
Popis: Metastatic phyllodes tumors have poor prognosis with median overall survival of 11.5 months. The objective of this study is to identify prognostic factors and the best options for management of metastatic malignant phyllode tumors (MMPTs). A multicentric retrospective study, including cases of MMPT from 10 sarcoma centers, was conducted. The primary end-point was overall survival (OS), and the secondary end-point was the clinical benefit of chemotherapy (CBCT) rate. 51 MMPT patients were included. Median time from diagnosis to metastatic recurrence was 13 months. Management of MMPT consisted in surgery of the metastatic disease for 16 patients (31.3%), radiation therapy of the metastatic disease for 15 patients (31.9%), and chemotherapy for 37 patients (72.5%). Median follow-up was 62.1 months [95% confidence interval (CI) 31–80 months]. Median OS was 11.5 months (95% CI 7.5–18.7 months). On multivariate analysis, two or more metastatic sites [hazard ratio (HR) 2.81, 95% CI 1.27–6.19; p = 0.01] and surgery of metastasis (HR 0.33, 95% CI 0.14–0.78; p = 0.01) were independently associated with OS. The CBCT rate was 31.4% and 16.7% for the first and second lines. Polychemotherapy was not superior to single-agent therapy. Alkylating-agent-based chemotherapy, possibly associated with anthracyclines, was associated with a better CBCT rate than anthracyclines alone (p = 0.049). The results of this study emphasize the impact of the number of metastatic sites on survival of MMPT patients and the leading role of metastasis surgery in MMPT management. If systemic therapy is used, it should include alkylating agents, which are associated with a better clinical benefit.
Databáze: OpenAIRE
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