背景:乳腺叶状肿瘤(PT)患者的最佳手术切缘宽度仍存在争议。这项研究的目的是评估边缘宽度对长期局部复发风险的影响。
方法:这是对2008-2015年确诊PT患者的单机构回顾性研究。边缘被定义为阳性(肿瘤上的墨水),狭窄(墨缘无肿瘤,但<10mm),或广泛自由(>/=10mm)。LR率通过Kaplan-Meier方法估计。
结果:在117名女性患者中,组织学包括55(47%)良性,29(25%)边界线,和33(28%)恶性PT。16位(14%)的最终利润率为正,32岁(27%),在64(55%)中广泛免费,5(4%)患者未知。与>10mm的边距相比,边缘窄阳性患者的LR风险较高[HR10.57(95%CI2.48-45.02)和HR5.66(95%CI1.19-26.99),分别]。在良性PT中,十年无LR利率是100%,94%,66%为广泛负面,狭窄,和正利润率,分别(p=0.056)。对于临界/恶性PT,10年期无LR利率分别为93%和57%,利润率普遍为负和窄小,分别为(p=0.02),窄边缘组和阳性边缘组的LR无差异(p=1.00)。
结论:对于良性PT,肿瘤上无墨水的边缘似乎足以优化局部控制。在患有交界性或恶性PT的患者中,获得较宽的手术切缘可能仍然很重要,因为与切缘阳性的患者相比,较窄的切缘与LR率相关.
BACKGROUND: Optimal surgical margin width for patients with phyllodes tumors (PTs) of the breast remains debated. The aim of this study was to assess the influence of margin width on long-term local recurrence risk.
METHODS: This was a single-institution retrospective review of patients with confirmed PT treated from 2008-2015. Margins were defined as positive (ink on tumor), narrow (no tumor at inked margin but < 10mm), or widely free (>/= 10mm). LR rates were estimated by the Kaplan-Meier method.
RESULTS: Among 117 female patients, histology included 55 (47%) benign, 29 (25%) borderline, and 33 (28%) malignant PT. Final margins were positive in 16 (14%), narrow in 32 (27%), widely free in 64 (55%), and unknown in 5 (4%) patients. Compared with margins > 10 mm, patients with positive and narrow margins had a higher LR risk [HR 10.57 (95% CI 2.48-45.02) and HR 5.66 (95% CI 1.19-26.99), respectively]. Among benign PTs, the 10-year LR-free rates were 100%, 94%, and 66% for widely negative, narrow, and positive margins, respectively (p = 0.056). For borderline/malignant PT, the 10-year LR-free rates were 93% and 57% for widely negative and narrow margins, respectively (p = 0.02), with no difference in LR between narrow and positive margin groups (p = 1.00).
CONCLUSIONS: For benign PTs, a margin of no ink on tumor appears sufficient to optimize local control. In patients with borderline or malignant PTs, achieving a wide surgical margin may remain important as narrower margins were associated with LR rates comparable to those with positive margins.