Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study
Background The optimal threshold of surgical margins for breast malignant phyllodes tumors (MPTs) and the impact of adjuvant chemotherapy and radiotherapy were investigated. Patients and Methods We conducted a multicenter nationwide retrospective study of all MPT cases with central pathological revi...
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| Veröffentlicht in: | Annals of surgical oncology 2020-06, Vol.27 (6), p.1818-1827 |
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| creator | Neron, Mathias Sajous, Christophe Thezenas, Simon Piperno-Neumann, Sophie Reyal, Fabien Laé, Marick Chakiba, Camille Michot, Audrey Penel, Nicolas Honoré, Charles Owen, Clémentine Bertucci, François Salas, Sébastien Saada-Bouzid, Esma Valentin, Thibaud Bompas, Emmanuelle Brahmi, Mehdi Ray-Coquard, Isabelle Blay, Jean-Yves Firmin, Nelly |
| description | Background
The optimal threshold of surgical margins for breast malignant phyllodes tumors (MPTs) and the impact of adjuvant chemotherapy and radiotherapy were investigated.
Patients and Methods
We conducted a multicenter nationwide retrospective study of all MPT cases with central pathological review within the French Sarcoma Group. Endpoints were local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) rates.
Results
Overall, 212 patients were included in the study. All non-metastatic patients underwent primary surgical treatment, including 58.6% of conservative surgeries. An R0 resection was achieved in 117 patients (59.4%: 26.9% of patients with 1–2 mm margins, 12.2% of patients with 3–7 mm margins, 20.3% of patients with ≥ 8 mm margins). Ninety-four patients (45%) underwent a second surgery (SS) to obtain R0 margins, with a final mastectomy rate of 72.6%. Radiotherapy and chemotherapy were performed in 91 (43.1%) and 23 patients (10.9%), respectively, but were not associated with better outcomes. Mastectomy was significantly associated with better LRFS (
p
8 mm) were not superior to margins of 3–7 mm (3–7 mm vs. > 8 mm; HR 0.81,
p
= 0.69). Age (HR 2.14,
p
= 0.038) and tumor necrosis (HR 1.96,
p
= 0.047) were found to be poor prognostic factors and were associated with MFS.
Conclusions
This study suggests that 3 mm margins are necessary and sufficient for surgical management of MPTs, and emphasizes the importance of SS to obtain clear margins in case of 0–1–2 mm margins. No impact of adjuvant chemotherapy or radiotherapy was detected in this study. |
| doi_str_mv | 10.1245/s10434-020-08217-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_03623684v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2347526987</sourcerecordid><originalsourceid>FETCH-LOGICAL-c409t-eaa07ff8cb8b2c7e75ad59b48c8f6222b40afa2fa0e6643c6a1d75b8bd9773453</originalsourceid><addsrcrecordid>eNp9kU1v1DAQhiNERT_gD3BAlrjAIcXfdrgtFaWVtgLR5Ww5zmTXq2yytZ2V8u_xktJKHDjN6J1nXnv0FsVbgi8J5eJTJJgzXmKKS6wpUeX0ojgjIktcavIy91jqsqJSnBbnMW4xJoph8ao4ZaTSFZPkrDjcj2Htne3Qnc1NH5HtG7RotuPB9gmtNhDs3kNEvs9E59f9Uf6xmbpuaLK8GndDiGhoUdoA-hLAxvQZLdDd2CXvoE8Q0E9IYYh7cMkfAN2nsZleFyet7SK8eawXxa_rr6urm3L5_dvt1WJZOo6rVIK1WLWtdrWuqVOghG1EVXPtdCsppTXHtrW0tRik5MxJSxolMtxUSjEu2EXxcfbd2M7sg9_ZMJnBenOzWJqjhpmkTGp-IJn9MLP7MDyMEJPZ-eig62wPwxgNZVwJKiutMvr-H3Q7jKHPlxjKMcZCKaozRWfK5fNjgPbpBwSbY4JmTtDkBM2fBM2Ul949Wo_1Dpqnlb-RZYDNQMyjfg3h-e3_2P4Gcw6nPw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2400057728</pqid></control><display><type>article</type><title>Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Neron, Mathias ; Sajous, Christophe ; Thezenas, Simon ; Piperno-Neumann, Sophie ; Reyal, Fabien ; Laé, Marick ; Chakiba, Camille ; Michot, Audrey ; Penel, Nicolas ; Honoré, Charles ; Owen, Clémentine ; Bertucci, François ; Salas, Sébastien ; Saada-Bouzid, Esma ; Valentin, Thibaud ; Bompas, Emmanuelle ; Brahmi, Mehdi ; Ray-Coquard, Isabelle ; Blay, Jean-Yves ; Firmin, Nelly</creator><creatorcontrib>Neron, Mathias ; Sajous, Christophe ; Thezenas, Simon ; Piperno-Neumann, Sophie ; Reyal, Fabien ; Laé, Marick ; Chakiba, Camille ; Michot, Audrey ; Penel, Nicolas ; Honoré, Charles ; Owen, Clémentine ; Bertucci, François ; Salas, Sébastien ; Saada-Bouzid, Esma ; Valentin, Thibaud ; Bompas, Emmanuelle ; Brahmi, Mehdi ; Ray-Coquard, Isabelle ; Blay, Jean-Yves ; Firmin, Nelly ; French Sarcoma Group (GSF-GETO) ; The French Sarcoma Group (GSF-GETO)</creatorcontrib><description>Background
The optimal threshold of surgical margins for breast malignant phyllodes tumors (MPTs) and the impact of adjuvant chemotherapy and radiotherapy were investigated.
Patients and Methods
We conducted a multicenter nationwide retrospective study of all MPT cases with central pathological review within the French Sarcoma Group. Endpoints were local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) rates.
Results
Overall, 212 patients were included in the study. All non-metastatic patients underwent primary surgical treatment, including 58.6% of conservative surgeries. An R0 resection was achieved in 117 patients (59.4%: 26.9% of patients with 1–2 mm margins, 12.2% of patients with 3–7 mm margins, 20.3% of patients with ≥ 8 mm margins). Ninety-four patients (45%) underwent a second surgery (SS) to obtain R0 margins, with a final mastectomy rate of 72.6%. Radiotherapy and chemotherapy were performed in 91 (43.1%) and 23 patients (10.9%), respectively, but were not associated with better outcomes. Mastectomy was significantly associated with better LRFS (
p
< 0.001). Margins of 0, 1, or 2 mm with SS were associated with better MFS (hazard ratio [HR] 0.3,
p
= 0.005) and OS (HR 0.32,
p
= 0.005) compared with margins of 0–1–2 mm without SS. Wider margins (> 8 mm) were not superior to margins of 3–7 mm (3–7 mm vs. > 8 mm; HR 0.81,
p
= 0.69). Age (HR 2.14,
p
= 0.038) and tumor necrosis (HR 1.96,
p
= 0.047) were found to be poor prognostic factors and were associated with MFS.
Conclusions
This study suggests that 3 mm margins are necessary and sufficient for surgical management of MPTs, and emphasizes the importance of SS to obtain clear margins in case of 0–1–2 mm margins. No impact of adjuvant chemotherapy or radiotherapy was detected in this study.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-020-08217-y</identifier><identifier>PMID: 31989361</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adjuvant therapy ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Breast ; Breast cancer ; Breast Neoplasms - pathology ; Breast Neoplasms - therapy ; Breast Oncology ; Cancer ; Chemoradiotherapy, Adjuvant - mortality ; Chemotherapy ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Life Sciences ; Margins of Excision ; Mastectomy - mortality ; Medical prognosis ; Medicine ; Medicine & Public Health ; Metastases ; Middle Aged ; Neoplasm Recurrence, Local - pathology ; Neoplasm Recurrence, Local - therapy ; Oncology ; Patients ; Phyllodes Tumor - pathology ; Phyllodes Tumor - therapy ; Prognosis ; Radiation therapy ; Retrospective Studies ; Sarcoma ; Surgery ; Surgical Oncology ; Survival ; Survival Rate ; Tumors ; Young Adult</subject><ispartof>Annals of surgical oncology, 2020-06, Vol.27 (6), p.1818-1827</ispartof><rights>Society of Surgical Oncology 2020</rights><rights>Society of Surgical Oncology 2020.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-eaa07ff8cb8b2c7e75ad59b48c8f6222b40afa2fa0e6643c6a1d75b8bd9773453</citedby><cites>FETCH-LOGICAL-c409t-eaa07ff8cb8b2c7e75ad59b48c8f6222b40afa2fa0e6643c6a1d75b8bd9773453</cites><orcidid>0000-0002-0007-5913 ; 0000-0001-5243-1548 ; 0000-0001-9915-2810 ; 0000-0001-5839-6261 ; 0000-0002-0157-0959 ; 0000-0001-7190-120X ; 0000-0003-2472-1219 ; 0000-0003-2472-8306 ; 0000-0002-2318-3589</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-020-08217-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-020-08217-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31989361$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://amu.hal.science/hal-03623684$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Neron, Mathias</creatorcontrib><creatorcontrib>Sajous, Christophe</creatorcontrib><creatorcontrib>Thezenas, Simon</creatorcontrib><creatorcontrib>Piperno-Neumann, Sophie</creatorcontrib><creatorcontrib>Reyal, Fabien</creatorcontrib><creatorcontrib>Laé, Marick</creatorcontrib><creatorcontrib>Chakiba, Camille</creatorcontrib><creatorcontrib>Michot, Audrey</creatorcontrib><creatorcontrib>Penel, Nicolas</creatorcontrib><creatorcontrib>Honoré, Charles</creatorcontrib><creatorcontrib>Owen, Clémentine</creatorcontrib><creatorcontrib>Bertucci, François</creatorcontrib><creatorcontrib>Salas, Sébastien</creatorcontrib><creatorcontrib>Saada-Bouzid, Esma</creatorcontrib><creatorcontrib>Valentin, Thibaud</creatorcontrib><creatorcontrib>Bompas, Emmanuelle</creatorcontrib><creatorcontrib>Brahmi, Mehdi</creatorcontrib><creatorcontrib>Ray-Coquard, Isabelle</creatorcontrib><creatorcontrib>Blay, Jean-Yves</creatorcontrib><creatorcontrib>Firmin, Nelly</creatorcontrib><creatorcontrib>French Sarcoma Group (GSF-GETO)</creatorcontrib><creatorcontrib>The French Sarcoma Group (GSF-GETO)</creatorcontrib><title>Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
The optimal threshold of surgical margins for breast malignant phyllodes tumors (MPTs) and the impact of adjuvant chemotherapy and radiotherapy were investigated.
Patients and Methods
We conducted a multicenter nationwide retrospective study of all MPT cases with central pathological review within the French Sarcoma Group. Endpoints were local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) rates.
Results
Overall, 212 patients were included in the study. All non-metastatic patients underwent primary surgical treatment, including 58.6% of conservative surgeries. An R0 resection was achieved in 117 patients (59.4%: 26.9% of patients with 1–2 mm margins, 12.2% of patients with 3–7 mm margins, 20.3% of patients with ≥ 8 mm margins). Ninety-four patients (45%) underwent a second surgery (SS) to obtain R0 margins, with a final mastectomy rate of 72.6%. Radiotherapy and chemotherapy were performed in 91 (43.1%) and 23 patients (10.9%), respectively, but were not associated with better outcomes. Mastectomy was significantly associated with better LRFS (
p
< 0.001). Margins of 0, 1, or 2 mm with SS were associated with better MFS (hazard ratio [HR] 0.3,
p
= 0.005) and OS (HR 0.32,
p
= 0.005) compared with margins of 0–1–2 mm without SS. Wider margins (> 8 mm) were not superior to margins of 3–7 mm (3–7 mm vs. > 8 mm; HR 0.81,
p
= 0.69). Age (HR 2.14,
p
= 0.038) and tumor necrosis (HR 1.96,
p
= 0.047) were found to be poor prognostic factors and were associated with MFS.
Conclusions
This study suggests that 3 mm margins are necessary and sufficient for surgical management of MPTs, and emphasizes the importance of SS to obtain clear margins in case of 0–1–2 mm margins. No impact of adjuvant chemotherapy or radiotherapy was detected in this study.</description><subject>Adjuvant therapy</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Breast</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - therapy</subject><subject>Breast Oncology</subject><subject>Cancer</subject><subject>Chemoradiotherapy, Adjuvant - mortality</subject><subject>Chemotherapy</subject><subject>Combined Modality Therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Life Sciences</subject><subject>Margins of Excision</subject><subject>Mastectomy - mortality</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Recurrence, Local - therapy</subject><subject>Oncology</subject><subject>Patients</subject><subject>Phyllodes Tumor - pathology</subject><subject>Phyllodes Tumor - therapy</subject><subject>Prognosis</subject><subject>Radiation therapy</subject><subject>Retrospective Studies</subject><subject>Sarcoma</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Tumors</subject><subject>Young Adult</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU1v1DAQhiNERT_gD3BAlrjAIcXfdrgtFaWVtgLR5Ww5zmTXq2yytZ2V8u_xktJKHDjN6J1nXnv0FsVbgi8J5eJTJJgzXmKKS6wpUeX0ojgjIktcavIy91jqsqJSnBbnMW4xJoph8ao4ZaTSFZPkrDjcj2Htne3Qnc1NH5HtG7RotuPB9gmtNhDs3kNEvs9E59f9Uf6xmbpuaLK8GndDiGhoUdoA-hLAxvQZLdDd2CXvoE8Q0E9IYYh7cMkfAN2nsZleFyet7SK8eawXxa_rr6urm3L5_dvt1WJZOo6rVIK1WLWtdrWuqVOghG1EVXPtdCsppTXHtrW0tRik5MxJSxolMtxUSjEu2EXxcfbd2M7sg9_ZMJnBenOzWJqjhpmkTGp-IJn9MLP7MDyMEJPZ-eig62wPwxgNZVwJKiutMvr-H3Q7jKHPlxjKMcZCKaozRWfK5fNjgPbpBwSbY4JmTtDkBM2fBM2Ul949Wo_1Dpqnlb-RZYDNQMyjfg3h-e3_2P4Gcw6nPw</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Neron, Mathias</creator><creator>Sajous, Christophe</creator><creator>Thezenas, Simon</creator><creator>Piperno-Neumann, Sophie</creator><creator>Reyal, Fabien</creator><creator>Laé, Marick</creator><creator>Chakiba, Camille</creator><creator>Michot, Audrey</creator><creator>Penel, Nicolas</creator><creator>Honoré, Charles</creator><creator>Owen, Clémentine</creator><creator>Bertucci, François</creator><creator>Salas, Sébastien</creator><creator>Saada-Bouzid, Esma</creator><creator>Valentin, Thibaud</creator><creator>Bompas, Emmanuelle</creator><creator>Brahmi, Mehdi</creator><creator>Ray-Coquard, Isabelle</creator><creator>Blay, Jean-Yves</creator><creator>Firmin, Nelly</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><general>Springer Verlag</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-0007-5913</orcidid><orcidid>https://orcid.org/0000-0001-5243-1548</orcidid><orcidid>https://orcid.org/0000-0001-9915-2810</orcidid><orcidid>https://orcid.org/0000-0001-5839-6261</orcidid><orcidid>https://orcid.org/0000-0002-0157-0959</orcidid><orcidid>https://orcid.org/0000-0001-7190-120X</orcidid><orcidid>https://orcid.org/0000-0003-2472-1219</orcidid><orcidid>https://orcid.org/0000-0003-2472-8306</orcidid><orcidid>https://orcid.org/0000-0002-2318-3589</orcidid></search><sort><creationdate>20200601</creationdate><title>Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study</title><author>Neron, Mathias ; Sajous, Christophe ; Thezenas, Simon ; Piperno-Neumann, Sophie ; Reyal, Fabien ; Laé, Marick ; Chakiba, Camille ; Michot, Audrey ; Penel, Nicolas ; Honoré, Charles ; Owen, Clémentine ; Bertucci, François ; Salas, Sébastien ; Saada-Bouzid, Esma ; Valentin, Thibaud ; Bompas, Emmanuelle ; Brahmi, Mehdi ; Ray-Coquard, Isabelle ; Blay, Jean-Yves ; Firmin, Nelly</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-eaa07ff8cb8b2c7e75ad59b48c8f6222b40afa2fa0e6643c6a1d75b8bd9773453</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adjuvant therapy</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Breast</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - therapy</topic><topic>Breast Oncology</topic><topic>Cancer</topic><topic>Chemoradiotherapy, Adjuvant - mortality</topic><topic>Chemotherapy</topic><topic>Combined Modality Therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Life Sciences</topic><topic>Margins of Excision</topic><topic>Mastectomy - mortality</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Recurrence, Local - therapy</topic><topic>Oncology</topic><topic>Patients</topic><topic>Phyllodes Tumor - pathology</topic><topic>Phyllodes Tumor - therapy</topic><topic>Prognosis</topic><topic>Radiation therapy</topic><topic>Retrospective Studies</topic><topic>Sarcoma</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Tumors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Neron, Mathias</creatorcontrib><creatorcontrib>Sajous, Christophe</creatorcontrib><creatorcontrib>Thezenas, Simon</creatorcontrib><creatorcontrib>Piperno-Neumann, Sophie</creatorcontrib><creatorcontrib>Reyal, Fabien</creatorcontrib><creatorcontrib>Laé, Marick</creatorcontrib><creatorcontrib>Chakiba, Camille</creatorcontrib><creatorcontrib>Michot, Audrey</creatorcontrib><creatorcontrib>Penel, Nicolas</creatorcontrib><creatorcontrib>Honoré, Charles</creatorcontrib><creatorcontrib>Owen, Clémentine</creatorcontrib><creatorcontrib>Bertucci, François</creatorcontrib><creatorcontrib>Salas, Sébastien</creatorcontrib><creatorcontrib>Saada-Bouzid, Esma</creatorcontrib><creatorcontrib>Valentin, Thibaud</creatorcontrib><creatorcontrib>Bompas, Emmanuelle</creatorcontrib><creatorcontrib>Brahmi, Mehdi</creatorcontrib><creatorcontrib>Ray-Coquard, Isabelle</creatorcontrib><creatorcontrib>Blay, Jean-Yves</creatorcontrib><creatorcontrib>Firmin, Nelly</creatorcontrib><creatorcontrib>French Sarcoma Group (GSF-GETO)</creatorcontrib><creatorcontrib>The French Sarcoma Group (GSF-GETO)</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Neron, Mathias</au><au>Sajous, Christophe</au><au>Thezenas, Simon</au><au>Piperno-Neumann, Sophie</au><au>Reyal, Fabien</au><au>Laé, Marick</au><au>Chakiba, Camille</au><au>Michot, Audrey</au><au>Penel, Nicolas</au><au>Honoré, Charles</au><au>Owen, Clémentine</au><au>Bertucci, François</au><au>Salas, Sébastien</au><au>Saada-Bouzid, Esma</au><au>Valentin, Thibaud</au><au>Bompas, Emmanuelle</au><au>Brahmi, Mehdi</au><au>Ray-Coquard, Isabelle</au><au>Blay, Jean-Yves</au><au>Firmin, Nelly</au><aucorp>French Sarcoma Group (GSF-GETO)</aucorp><aucorp>The French Sarcoma Group (GSF-GETO)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>27</volume><issue>6</issue><spage>1818</spage><epage>1827</epage><pages>1818-1827</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
The optimal threshold of surgical margins for breast malignant phyllodes tumors (MPTs) and the impact of adjuvant chemotherapy and radiotherapy were investigated.
Patients and Methods
We conducted a multicenter nationwide retrospective study of all MPT cases with central pathological review within the French Sarcoma Group. Endpoints were local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) rates.
Results
Overall, 212 patients were included in the study. All non-metastatic patients underwent primary surgical treatment, including 58.6% of conservative surgeries. An R0 resection was achieved in 117 patients (59.4%: 26.9% of patients with 1–2 mm margins, 12.2% of patients with 3–7 mm margins, 20.3% of patients with ≥ 8 mm margins). Ninety-four patients (45%) underwent a second surgery (SS) to obtain R0 margins, with a final mastectomy rate of 72.6%. Radiotherapy and chemotherapy were performed in 91 (43.1%) and 23 patients (10.9%), respectively, but were not associated with better outcomes. Mastectomy was significantly associated with better LRFS (
p
< 0.001). Margins of 0, 1, or 2 mm with SS were associated with better MFS (hazard ratio [HR] 0.3,
p
= 0.005) and OS (HR 0.32,
p
= 0.005) compared with margins of 0–1–2 mm without SS. Wider margins (> 8 mm) were not superior to margins of 3–7 mm (3–7 mm vs. > 8 mm; HR 0.81,
p
= 0.69). Age (HR 2.14,
p
= 0.038) and tumor necrosis (HR 1.96,
p
= 0.047) were found to be poor prognostic factors and were associated with MFS.
Conclusions
This study suggests that 3 mm margins are necessary and sufficient for surgical management of MPTs, and emphasizes the importance of SS to obtain clear margins in case of 0–1–2 mm margins. No impact of adjuvant chemotherapy or radiotherapy was detected in this study.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31989361</pmid><doi>10.1245/s10434-020-08217-y</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-0007-5913</orcidid><orcidid>https://orcid.org/0000-0001-5243-1548</orcidid><orcidid>https://orcid.org/0000-0001-9915-2810</orcidid><orcidid>https://orcid.org/0000-0001-5839-6261</orcidid><orcidid>https://orcid.org/0000-0002-0157-0959</orcidid><orcidid>https://orcid.org/0000-0001-7190-120X</orcidid><orcidid>https://orcid.org/0000-0003-2472-1219</orcidid><orcidid>https://orcid.org/0000-0003-2472-8306</orcidid><orcidid>https://orcid.org/0000-0002-2318-3589</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2020-06, Vol.27 (6), p.1818-1827 |
| issn | 1068-9265 1534-4681 |
| language | eng |
| recordid | cdi_hal_primary_oai_HAL_hal_03623684v1 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adjuvant therapy Adolescent Adult Aged Aged, 80 and over Breast Breast cancer Breast Neoplasms - pathology Breast Neoplasms - therapy Breast Oncology Cancer Chemoradiotherapy, Adjuvant - mortality Chemotherapy Combined Modality Therapy Female Follow-Up Studies Humans Life Sciences Margins of Excision Mastectomy - mortality Medical prognosis Medicine Medicine & Public Health Metastases Middle Aged Neoplasm Recurrence, Local - pathology Neoplasm Recurrence, Local - therapy Oncology Patients Phyllodes Tumor - pathology Phyllodes Tumor - therapy Prognosis Radiation therapy Retrospective Studies Sarcoma Surgery Surgical Oncology Survival Survival Rate Tumors Young Adult |
| title | Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T18%3A03%3A40IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_hal_p&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Surgical%20Margins%20and%20Adjuvant%20Therapies%20in%20Malignant%20Phyllodes%20Tumors%20of%20the%20Breast:%20A%20Multicenter%20Retrospective%20Study&rft.jtitle=Annals%20of%20surgical%20oncology&rft.au=Neron,%20Mathias&rft.aucorp=French%20Sarcoma%20Group%20(GSF-GETO)&rft.date=2020-06-01&rft.volume=27&rft.issue=6&rft.spage=1818&rft.epage=1827&rft.pages=1818-1827&rft.issn=1068-9265&rft.eissn=1534-4681&rft_id=info:doi/10.1245/s10434-020-08217-y&rft_dat=%3Cproquest_hal_p%3E2347526987%3C/proquest_hal_p%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2400057728&rft_id=info:pmid/31989361&rfr_iscdi=true |