The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases.

BACKGROUND: The study addresses the controversial prognostic and therapeutic aspects of phyllodes tumor of the breast. METHODS: Records of 170 women with phyllodes tumor of the breast were reviewed. On the basis of the criteria proposed by Azzopardi and Salvadori et al., including estimation of tumor margin, growth of the connective tissue component, mitoses, and cellular atypia, the entire series was divided into three histotypes of phyllodes tumor, i.e., benign (92 cases, 54.1%), borderline (19 cases, 11.2%), and malignant (59 cases, 34.7%). Ninety-eight patients (57.6%) were treated by wide local excision (79 benign, 15 borderline, and 4 malignant), 43 (25.3%) by simple mastectomy (13 benign, 4 borderline, and 26 malignant), and 29 (17.1%) by radical mastectomy (all malignant). RESULTS: Of the 170 treated patients, 141 (82.9%) survived 5 years without evidence of disease. In the Cox multivariate analysis the histotype of the tumor was the only independent prognostic factor: 5-year NED survival was observed in 95.7% of the patients with benign phyllodes tumor, 73.7% with borderline phyllodes tumor, and 66.1% with malignant phyllodes tumor. After a wide local excision 98.7% of the patients with benign tumor, and 80% with borderline tumor, were cured. Local recurrence was found in 14 patients (8.2%) (4 benign, 3 borderline, and 7 malignant); 10 of these underwent reoperation (7 wide local excision, 3 radical mastectomy) and survived 5 years NED. CONCLUSIONS: The histotype of phyllodes tumor (benign, borderline, and malignant), assessed on the basis of the criteria proposed by Azzopardi and Salvadori et al., was the only prognostic factor in our group of patients. Based on the data from literature and our own observations, we observed that a wide local excision, with an adequate margin of normal breast tissue, is the preferred initial therapy for phyllodes tumor of the breast.

Malignant phyllodes tumours of the breast. A clinical and pathological analysis of 55 cases.

55 cases of malignant phyllodes tumours of the breast are described. 36 patients (i.e. 65.5%) of the studied group survived 5 years with no evidence of disease after surgery. It was proved that a simple mastectomy is sufficient therapy for patients with tumour limited to the breast. Metastases to the axillary lymphatic nodes are very rare. The main reason for treatment failure is distant metastases in the lungs. The only prognostic factor in the studied group was the grade of histological malignancy, determined by such criteria as the ratio between the malignant sarcomatous tissue and that typical for phyllodes tumour, the degree of cell polymorphism, mitotic activity, and possible multidirectional differentiation (towards malignant neoplasms of soft tissue and bones).