Abstract
Background: Malignant phyllodes tumor (MPT) is a rare but aggressive breast malignancy. The aim of this study was to evaluate parameters that influence outcome in patients with MPT.
Methods: Fifty women were diagnosed with MPT of the breast and treated between August 1971 and July 2000. All medical records were reviewed retrospectively. The Cox regression model was used for multivariate analysis.
Results: Tumors were classified as borderline (6%), low grade (32%), or high grade (62%). The median patient age was 46 years (range, 14–77 years). The median tumor diameter was 3.5 cm (range, 1.5–18 cm). Twenty-two patients had wide local excision (WLE), and 28 patients had mastectomy. The median follow-up was 91 months (range, 12–360 months). Local recurrence (LR) occurred in 16 patients (32%) an average of 26 months after surgery (median, 17 months; range, 3–72 months). Distant metastasis occurred in 13 patients (26%) at an average of 53.4 months (median, 36 months; range, 4–177 months). Sixteen (32%) patients have died of their disease. LR was significantly increased with stromal overgrowth (P < .0001), large tumor size (P = .0177), and surgical margins <1 cm (P = .0120), but not with WLE (P = .5099). Stromal overgrowth was the only independent variable predictive of systemic metastasis (P < .0001) and patient survival (P < .0001).
Conclusions: Stromal overgrowth in MPT carries a grave prognosis. Close surgical margins and large tumor size, but not type of operation, significantly increased LR. Either WLE with adequate margins or mastectomy is an appropriate treatment for patients with MPT.
Similar content being viewed by others
REFERENCES
Rowell MD, Perry RR, Hsiu JG, Barranco SC. Phyllodes tumors. Am J Surg 1993; 165: 376–9.
Reinfuss M, Mitus J, Duda K, Stelmach A, Rys J, Smolak K. The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases. Cancer 1996; 77: 910–6.
Moffat CJ, Pinder SE, Dixon AR, Elston CW, Blamey RW, Ellis IO. Phyllodes tumours of the breast: a clinicopathological review of thirty-two cases. Histopathology 1995; 27: 205–18.
Chaney AW, Pollack A, McNeese MD, et al. Primary treatment for cystosarcoma phyllodes of the breast. Cancer 2000; 89: 1502–11.
Cohn-Cedermark G, Rutqvist LE, Rosendahl I, Silversward C. Prognostic factors in cystosarcoma: a clinicopathologic study of 77 patients. Cancer 1991; 68: 2017–22.
Salvadori B, Cusumano F, Del Bo R, et al. Surgical treatment of phyllodes tumors of the breast. Cancer 1989; 63: 2532–6.
Zıssıs C, Apostolikas N, Konstantinidou A, Griniatsos J, Vassilopoulos PP. The extent of surgery and prognosis of patients with phyllodes tumor of the breast. Breast Cancer Res Treat 1998; 48: 205–10.
Palmer ML, De Risi DC, Pelikan A, et al. Treatment options and recurrence potential for cystosarcoma phyllodes. Surg Gynecol Obstet 1990; 170: 193–6.
Rajan PB, Cranor ML, Rosen PP. Cystosarcoma phyllodes in adolescent girls and young women: a study of 45 patients. Am J Surg Pathol 1998; 22: 64–9.
Modena S, Prati G, Mainente M, et al. Phyllodes tumor of the breast: problems of differential diagnosis and therapeutic approach from an analysis of 17 cases. Eur J Surg Oncol 1993; 19: 70–3.
Azzopardi JG, Ahmed A, Millis RR. Problems in breast pathology. Major Probl Pathol 1979; 11: 1–466.
Turalba CI, el-Mahdi AM, Ladaga L. Fatal metastatic cystosarcoma phyllodes in an adolescent female: case report and review of treatment approaches. J Surg Oncol 1986; 33: 176–81.
Faraci RP, Schour L. Radical treatment of recurrent cytosarcoma phylloides. Ann Surg 1974; 180: 796–8.
Hajdu SI, Espinosa MH, Robbins GF. Recurrent cystosarcoma phyllodes: a clinicopathologic study of 32 cases. Cancer 1975; 38: 1402–5.
Fernandez BB, Hernanzez FJ, Spindler W. Metastatic cystosarcoma phyllodes: a light and electron microscopic study. Cancer 1976; 37: 1737–46.
Vorherr H, Vorherr UF, Kutvirt DM, Key CR. Cystosarcoma phyllodes: epidemiology, pathohistology, pathobiology, diagnosis, therapy, and survival. Arch Gynecol 1985; 236: 173–81.
Pandey M, Mathew A, Kattoor J, et al. Malignant phyllodes tumor. Breast J 2001; 7: 411–6.
Kapiris I, Nasiri N, A’Hern R, Healy V, Gui GP. Outcome and predictive factors of local recurrence and distant metastases following primary surgical treatment of high-grade malignant phyllodes tumours of the breast. Eur J Surg Oncol 2001; 27: 723–30.
Reinfuss M, Mitus J, Smolak K, Stelmach A. Malignant phyllodes tumours of the breast. A clinical and pathological analysis of 55 cases. Eur J Cancer 1993; 29A: 1252–6.
Ciatto S, Bonardi R, Cataliotti L, Cardona G. Phyllodes tumor of the breast: a multicenter series of 59 cases. Coordinating Center and Writing Committee of FONCAM (National Task Force for Breast Cancer), Italy. Eur J Surg Oncol 1992; 18: 545–9.
Zurrida S, Bartoli C, Galimberti V, et al. Which therapy for unexpected phyllode tumour of the breast? Eur J Cancer 1992; 28: 654–7.
Stebbing JF, Nash AG. Diagnosis and management of phyllodes tumour of the breast: experience of 33 cases at a specialist centre. Ann R Coll Surg Engl 1995; 77: 181–4.
Staren ED, Lynch G, Boyle C, Witt TR, Bines SD. Malignant cystosarcoma phyllodes. Am Surg 1994; 60: 583–5.
Barth RJ Jr. Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat 1999; 57: 291–5.
Chua CL, Thomas A, Ng BK. Cystosarcoma phyllodes: a review of surgical options. Surgery 1989; 105: 141–7.
Hines JR, Murad TM, Beal JM. Prognostic indicators in cystosarcoma phylloides. Am J Surg 1987; 153: 276–80.
Grimes MM. Cystosarcoma phyllodes of the breast: histologic features, flow cytometric analysis, and clinical correlations. Mod Pathol 1992; 5: 232–9.
Mangi AA, Smith BL, Gadd MA, Tanabe KK, Ott MJ, Souba WW. Surgical management of phyllodes tumors. Arch Surg 1999; 134: 487–92.
Pietruszka M, Barnes L. Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases. Cancer 1978; 41: 1974–83.
Parker SJ, Harries SA. Phyllodes tumours. Postgrad Med J 2001; 77: 428–35.
Norris HJ, Taylor HB. Relationship of histologic features to behavior of cystosarcoma phyllodes. Analysis of ninety-four cases. Cancer 1967; 20: 2090–9.
Hawkins RE, Schofield JB, Fisher C, Wiltshaw E, McKinna JA. The clinical and histologic criteria that predict metastases from cystosarcoma phyllodes. Cancer 1992; 69: 141–7.
West TL, Weiland LH, Clagett OT. Cystosarcoma phyllodes. Ann Surg 1971; 173: 520–8.
Ward RM, Evans HL. Cystosarcoma phyllodes. A clinicopathologic study of 26 cases. Cancer 1986; 58: 2282–9.
Kario K, Maeda S, Mizuno Y, Makino Y, Tankawa H, Kitazawa S. Phyllodes tumor of the breast: a clinicopathologic study of 34 cases. J Surg Oncol 1990; 45: 46–51.
Noguchi S, Motomura K, Inaji H, Imaoka S, Koyama H. Clonal analysis of fibroadenoma and phyllodes tumor of the breast. Cancer Res 1993; 53: 4071–4.
Burton GV, Hart LL, Leight GS Jr, Iglehart JD, McCarty KS Jr, Cox EB. Cystosarcoma phyllodes. Effective therapy with cisplatin and etoposide chemotherapy. Cancer 1989; 63: 2088–92.
Hopkins ML, McGowan TS, Rawlings G, et al. Phylloides tumor of the breast: a report of 14 cases. J Surg Oncol 1994; 56: 108–12.
Stockdale AD, Leader M. Phyllodes tumour of the breast: response to radiotherapy. Clin Radiol 1987; 38: 287.
August DA, Kearney T. Cystosarcoma phyllodes: mastectomy, lumpectomy, or lumpectomy plus irradiation. Surg Oncol 2000; 9: 49–52.
Guerrero MA, Ballard BR, Grau AM. Malignant phyllodes tumor of the breast: review of the literature and case report of stromal overgrowth. Surg Oncol 2003; 12: 27–37.
Contarini O, Urdaneta LF, Hagan W, Stephenson SE Jr. Cystosarcoma phylloides of the breast: a new therapeutic proposal. Am Surg 1982; 48: 157–66.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Asoglu, O., Ugurlu, M.M., Blanchard, K. et al. Risk Factors for Recurrence and Death After Primary Surgical Treatment of Malignant Phyllodes Tumors. Ann Surg Oncol 11, 1011–1017 (2004). https://doi.org/10.1245/ASO.2004.02.001
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1245/ASO.2004.02.001