Malignant phyllodes tumors of the breast: the malignancy grading and associations with prognosis.
Heterologous elements
Malignancy grade
Malignant phyllodes tumors
Prognosis
Journal
Breast cancer research and treatment
ISSN: 1573-7217
Titre abrégé: Breast Cancer Res Treat
Pays: Netherlands
ID NLM: 8111104
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
01
12
2022
accepted:
30
03
2023
medline:
15
5
2023
pubmed:
19
4
2023
entrez:
18
4
2023
Statut:
ppublish
Résumé
This study aimed to correlate clinicopathological parameters with survival outcomes in a cohort of patients diagnosed with malignant phyllodes tumors (MPTs). We also analyzed the malignancy grade of MPTs and investigated the prognostic significance of the malignancy grading system. Clinicopathological parameters, malignancy grades, and clinical follow-up data of 188 women diagnosed with MPTs in a single-institution were analyzed. MPTs of the breast were grouped according to stromal atypia, stromal overgrowth, mitotic count, tumor differentiation, and necrosis. A Fleiss' kappa statistic was calculated to test the agreement between the pathologists for the grading of MPTs. Disease-free survival (DFS), distant metastasis-free survival (DMFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared between groups using the log-rank test. Cox regression was carried out to identify factors predictive of locoregional recurrence (LRR), distant metastasis (DM) and death. A total of 188 MPTs were classified according to the malignancy grading system: 88 (46.8%) as low grade, 77 (41%) as an intermediate grade, and 23 (12.2%) as high grade. Excellent agreement between pathologists for the grading of MPTs (Fleiss' kappa 0.807). In our study population, the occurrence of DM and death were associated with the malignancy grade of MPTs (P < 0.001). Based on the DFS curves, the presence of heterologous elements (P = 0.025) and younger age (P = 0.014) were independent prognostic indicators. Additionally, the malignancy grade retained independent prognostic significance for predicting DMFS and OS (P < 0.001 and P = 0.009). Higher malignancy grade, presence of heterologous elements, younger age, larger tumor size, and recent rapid tumor growth are poor prognostic factors for MPTs of the breast. The malignancy grading system may be generalized in the future.
Identifiants
pubmed: 37071267
doi: 10.1007/s10549-023-06933-z
pii: 10.1007/s10549-023-06933-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
435-444Subventions
Organisme : Science & Technology Development Fund of Tianjin Education Commission for Higher Education
ID : 2017KJ203
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Alloson Kimberly H, Brogi Edi, Ellis Ian O et al (2019) WHO classification of tumours editorial board. Breast tumours. WHO, Lyon
Bernstein L, Deapen D, Ross RK (1993) The descriptive epidemiology of malignant cystosarcoma phyllodes tumors of the breast. Cancer 71:3020–3024
doi: 10.1002/1097-0142(19930515)71:10<3020::AID-CNCR2820711022>3.0.CO;2-G
pubmed: 8387873
Tan PH, Jayabaskar T, Chuah KL et al (2005) Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol 123:529–540
doi: 10.1309/U6DVBFM81MLJC1FN
pubmed: 15743740
Parker SJ, Harries SA (2001) Phyllodes tumours. Postgrad Med J 77:428–435
doi: 10.1136/pmj.77.909.428
pubmed: 11423590
pmcid: 1760996
Vorherr H, Vorherr UF, Kutvirt DM et al (1985) Cystosarcoma phyllodes: epidemiology, pathohistology, pathobiology, diagnosis, therapy, and survival. Arch Gynecol 36:173–181
doi: 10.1007/BF02133961
Zhang Y, Kleer CG (2016) Phyllodes tumor of the breast: histopathologic features, differential diagnosis, and molecular/genetic updates. Arch Pathol Lab Med 140:665–671
doi: 10.5858/arpa.2016-0042-RA
pubmed: 27362571
Chen WH, Cheng SP, Tzen CY et al (2005) Surgical treatment of phyllodes tumors of the breast: retrospective review of 172 cases. J Surg Oncol 91:185–194
doi: 10.1002/jso.20334
pubmed: 16118768
Harris JR, Lippman ME, Morrow M et al (2004) Disease of the breast, 3rd edn. Lippincott Williams & Wilkins publishers, Philadelphia
McDivitt RW, Urban JA, Farrow JH (1967) Cystosarcoma phyllodes. Johns Hopkins Med J 120:33–45
pubmed: 4289572
Barth RJ Jr (1999) Histologic features predict local recurrence after breast conserving therapy of phyllodes tumors. Breast Cancer Res Treat 57:291–295
doi: 10.1023/A:1006260225618
pubmed: 10617306
Gong C, Nie Y, Qu S et al (2014) miR-21 induces myofibroblast differentiation and promotes the malignant progression of breast phyllodes tumors. Cancer Res 16:4341–4352
doi: 10.1158/0008-5472.CAN-14-0125
Moffat CJ, Pinder SE, Dixon AR et al (1995) Phyllodes tumours of the breast: a clinicopathological review of thirty-two cases. Histopathology 27:205–218
doi: 10.1111/j.1365-2559.1995.tb00212.x
pubmed: 8522284
Macdonald OK, Lee CM, Tward JD et al (2006) Malignant phyllodes tumor of the female breast: association of primary therapy with cause-specific survival from the surveillance, epidemiology, and end results (SEER) program. Cancer 107:2127–2133
doi: 10.1002/cncr.22228
pubmed: 16998937
Chaney AW, Pollack A, McNeese MD et al (2000) Primary treatment of cystsarcoma phyllodes of the breast. Cancer 89:1502–1511
doi: 10.1002/1097-0142(20001001)89:7<1502::AID-CNCR13>3.0.CO;2-P
pubmed: 11013364
Fou A, Schnabel FR, Hamele-Bena D et al (2006) Long-term outcomes of malignant phyllodes tumors patients: an institutional experience. Am J Surg 192:492–495
doi: 10.1016/j.amjsurg.2006.06.017
pubmed: 16978957
Kim S, Kim JY, Kim do H et al (2013) Analysis of phyllodes tumor recurrence according to the histologic grade. Breast Cancer Res Treat 141:353–363
doi: 10.1007/s10549-013-2684-x
pubmed: 24062207
Tan PH, Thike AA, Tan WJ et al (2012) Predicting clinical behaviour of breast phyllodes tumours: a nomogram based on histological criteria and surgical margins. J Clin Pathol 65:69–76
doi: 10.1136/jclinpath-2011-200368
pubmed: 22049216
Barrio AV, Clark BD, Goldberg JI et al (2007) Clinicopathologic features and long-term outcomes of 293 phyllodes tumors of the breast. Ann Surg Oncol 14:2961–2970
doi: 10.1245/s10434-007-9439-z
pubmed: 17562113
Abe M, Miyata S, Nishimura S et al (2011) Malignant transformation of breast fibroadenoma to malignant phyllodes tumor: long-term outcome of 36 malignant phyllodes tumors. Breast Cancer 18:268–272
doi: 10.1007/s12282-009-0185-x
pubmed: 22121516
Singhal V, Cosgrove JM (2011) Osteogenic sarcoma of the breast arising in a cystosarcoma phyllodes: a case report and review of the literature. J Med Case Rep 5:293
doi: 10.1186/1752-1947-5-293
pubmed: 21831335
pmcid: 3156761
Silver SA, Tavassoli FA (1999) Osteosarcomatous differentiation in phyllodes tumors. Am J Surg Pathol 23:815–821
doi: 10.1097/00000478-199907000-00010
pubmed: 10403305
Buchanan EB (1995) Cystosarcoma phyllodes and its surgical management. Am Surg 61:350–355
pubmed: 7893104
Salvadori B, Cusumano F, Del Bo R et al (1989) Surgical treatment of phyllodes tumors of the breast. Cancer 63:2532–2536
doi: 10.1002/1097-0142(19890615)63:12<2532::AID-CNCR2820631229>3.0.CO;2-Q
pubmed: 2541890
Geppert M, Bachmann FF (1982) Rare presentations of cytosarcoma phylloides. Geburtshilfe Frauenheilkd 42:732–735
doi: 10.1055/s-2008-1037152
pubmed: 6293909
Staren ED, Lynch G, Boyle C et al (1994) Malignant cystosarcoma phyllodes. Am Surg 60:583–585
pubmed: 8030812
Zissis C, Apostolikas N, Konstantinidou A et al (1998) The extent of surgery and prognosis of patients with phyllodes tumor of the breast. Breast Cancer Res Treat 48:205–210
doi: 10.1023/A:1005980831359
pubmed: 9598867
Asoglu O, Ugurlu MM, Blanchard K et al (2004) Risk factors for recurrence and death after primary surgical treatment of malignant phyllodes tumors. Ann Surg Oncol 11:1011–1017
doi: 10.1245/ASO.2004.02.001
pubmed: 15525831