Predictive factors of local recurrence and survival following primary surgical treatment of phyllodes tumors of the breast.
The phyllodes tumor is characterized by its tendency to recur locally and occasionally to metastasize. Local recurrence and death from metastases are occasional, but consistent, theme in reports of patients with phyllodes tumors (PTs). The aim of this study was to determine parameters that influence outcome in this uncommon neoplasm. Data from 79 patients with phyllodes tumors were reviewed retrospectively, reclassifying the pathological material using the World Health Organization (WHO) criteria. The median age of the patients was 42 years with a range from 16 to 70 years. The tumor size ranged from 2.5 to 24 cm, with a median of 11 cm. Based on the criteria proposed by WHO, 31 cases were benign tumors (39.2%), 27 borderline tumors (34.2%), and 21 malignant tumors (26.6%). The median duration of follow up was 60 months ranging from 3 to 138 months. Following local excision, the local recurrence rates were 14.3%, 50%, and 75% in patients with benign, borderline, and malignant tumors; respectively, while after wide local excision the local recurrence rates were 0%, 36.3% and 40%; respectively. Whereas, 0%, 8.3%, and 8.3% of patients with benign, borderline and malignant tumors; respectively, locally recurred after mastectomy. The 5-year disease free survival was 63.3% after local excision, 70% after wide local excision, and was 87% after mastectomy (p=0.04). Distant metastases (DM) were recorded in 10 patients (12.6%) after a median duration of 14 months (range 3- 36). All cases with DM died after an average of 5 months with a range of 1 to 11 months. Distant metastases developed in 3.2%, 11.1%, and in 28.6% of patients with benign, borderline and malignant tumors; respectively. The 5-year survival with no evidence of disease was 90% for the patients with benign tumors compared to 69% for borderline and 61% for malignant PTs (p= 0.02). The histotype of phyllodes tumors and resection margins were the principal determinants of local recurrence and distant metastases. Complete surgical excision by either wide local excision or mastectomy if necessary is important in the primary surgical treatment of phyllodes tumors.