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  • [Clin Breast Cancer.] The Characteristics of Local Recurrence After Breast-Conserving Surgery Alone for Malignant and Borderline Phyllodes Tumors of the Breast (KROG 16-08).

    서울의대, 울산의대 / 최누리, 김규보, 신경환*, 안승도*

  • 출처
    Clin Breast Cancer.
  • 등재일
    2019 Oct
  • 저널이슈번호
    19(5):345-353.e2. doi: 10.1016/j.clbc.2019.04.003. Epub 2019 Apr 11.
  • 내용

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    Abstract
    BACKGROUND:
    Despite margin-negative breast-conserving surgery (BCS), phyllodes tumors (PT) of the breast show high local recurrence (LR) rates. In this study we aimed to assess the site and grade of LR to identify high-risk patients after initial treatment of malignant and borderline PT using BCS alone.

    PATIENTS AND METHODS:
    From 1981 to 2014, 312 patients with malignant (n = 164) and borderline (n = 148) PT were treated using BCS alone at 10 centers. LR was defined as true recurrence (TR) if < 2 cm from the primary tumor bed and as elsewhere failure (EF) if otherwise.

    RESULTS:
    At a median of 21 months, LR occurred in 17.6% (55 of 312), 18.9% (31 of 164) among malignant and 16.2% (24 of 148) among borderline PT (P = .636). Only 1.9% (6 of 312) had EF. Five-year cumulative LR rates were 14.7% and 35.9% after margin-negative and -positive BCS, respectively (P < .001). Positive margin was an independent risk factor for TR (P = .002) and EF (P = .002). In multivariable competing risk regression of patients with negative margins < 1 cm (n = 115), age < 35 years (P = .001), and tumor size ≥ 5 cm (P = .008) independently increased LR risk. Of patients who experienced a LR, 30.9% (17 of 55) had a second or third repeated event. Borderline-to-malignant transformation rates increased at each LR event: 4.1% (6 of 148), 12.5% (3 of 24), and 77.8% (7 of 9) at first, second, and third LR, respectively (P = .006).

    CONCLUSION:
    LRs almost always develop near the primary tumor bed. Many patients experience multiple events, with heightened risk of borderline-to-malignant transformation at each subsequent event. For patients with negative margins < 1 cm, younger age and larger tumor size are independent risk factors for increased LR.

     


    Author information

    Choi N1, Kim K2, Shin KH3, Kim Y4, Moon HG4, Park W5, Choi DH5, Kim SS6, Ahn SD7, Kim TH8, Chun M9, Kim YB10, Kim S11, Choi BO12, Kim JH13
    1
    Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea; Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, Korea.
    2
    Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
    3
    Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. Electronic address: shin.kyunghwan@gmail.com.
    4
    Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
    5
    Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
    6
    Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
    7
    Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: sdahn@amc.seoul.kr.
    8
    Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
    9
    Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.
    10
    Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
    11
    Department of Radiation Oncology, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
    12
    Department of Radiation Oncology, Seoul St Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
    13
    Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

  • 키워드
    Adjuvant therapy; Malignant transformation; Radiotherapy; Risk factors; Tumor bed recurrence
  • 편집위원

    드문 종양인 유방의 엽상종양에서 유방보존수술 후 국소재발의 양상을 분석한 논문으로, 방사선치료의 적응증 및 적정 치료범위에 대한 정보를 제공하고 있다.

    2019-11-29 16:28:13

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