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Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgment

The authors are grateful to all the patients and their families. They also thank Dr. Hélène de Forges for substantive editing, Dr. Francoise Ducimetière for data management, and Dr Sebastien Carrere, Dr Carmen Llacer, Dr Aurélie Maran-Gonzalez, Dr. Didier Cupissol, Dr. Alexandre de Nonneville, Dr. Maud Toulmonde, Dr Nicolas Isambert and Dr Pascale Dubray-Longeras for patient inclusions.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Mathias Neron and Christophe Sajous contributed equally to this work.

Authors and Affiliations

  1. Department of Surgical Oncology, Institut du Cancer Montpellier (ICM), Univ Montpellier, Montpellier, France

    Mathias Neron MD

  2. Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France

    Christophe Sajous MD, Mehdi Brahmi MD, PhD, Isabelle Ray-Coquard MD, PhD & Jean-Yves Blay MD, PhD

  3. Department of Biostatistics, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France

    Simon Thezenas PhD

  4. Department of Medical Oncology, Institut Curie, Paris, France

    Sophie Piperno-Neumann MD

  5. Department of Surgical Oncology, Institut Curie, Paris, France

    Fabien Reyal MD, PhD

  6. Department of Pathology, Institut Curie, Paris, France

    Marick Laé MD

  7. Department of Medical Oncology, Institut Bergonié, Bordeaux, France

    Camille Chakiba MD

  8. Department of Surgical Oncology, Institut Bergonié, Bordeaux, France

    Audrey Michot MD

  9. Department of Medical Oncology, Institut Oscar Lambret, Lille, France

    Nicolas Penel MD, PhD

  10. Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France

    Charles Honoré MD, PhD & Clémentine Owen MD

  11. Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France

    François Bertucci MD, PhD

  12. Department of Medical Oncology, CHU La Timone, Marseille, France

    Sébastien Salas MD, PhD

  13. Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France

    Esma Saada-Bouzid MD, PhD

  14. Department of Medical Oncology, IUCT Oncopole, Toulouse, France

    Thibaud Valentin MD

  15. Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Nantes, France

    Emmanuelle Bompas MD

  16. Department of Medical Oncology, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France

    Nelly Firmin MD

Authors
  1. Mathias Neron MD
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  2. Christophe Sajous MD
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  17. Mehdi Brahmi MD, PhD
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  18. Isabelle Ray-Coquard MD, PhD
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  19. Jean-Yves Blay MD, PhD
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  20. Nelly Firmin MD
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Consortia

The French Sarcoma Group (GSF-GETO)

Corresponding author

Correspondence to Mathias Neron MD.

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Disclosure

Mathias Neron, Christophe Sajous, Simon Thezenas, Sophie Piperno-Neumann, Fabien Reyal, Marick Laé, Camille Chakiba, Audrey Michot, Nicolas Penel, Charles Honoré, Clémentine Owen, François Bertucci, Sébastien Salas, Esma Saada-Bouzid, Thibaud Valentin, Emmanuelle Bompas, Mehdi Brahmi, Isabelle Ray-Coquard, Jean-Yves Blay, and Nelly Firmin have no conflicts of interest to declare for this study.

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Neron, M., Sajous, C., Thezenas, S. et al. Surgical Margins and Adjuvant Therapies in Malignant Phyllodes Tumors of the Breast: A Multicenter Retrospective Study. Ann Surg Oncol 27, 1818–1827 (2020). https://doi.org/10.1245/s10434-020-08217-y

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  • DOI: https://doi.org/10.1245/s10434-020-08217-y

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