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Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines.

Publication ,  Journal Article
Rosenberger, LH; Thomas, SM; Nimbkar, SN; Hieken, TJ; Ludwig, KK; Jacobs, LK; Miller, ME; Gallagher, KK; Wong, J; Neuman, HB; Tseng, J ...
Published in: J Clin Oncol
January 20, 2021

PURPOSE: Phyllodes tumors (PTs) are rare breast neoplasms, which have little granular data on margins. Current guidelines recommend ≥ 1 cm margins; however, recent data suggest narrower margins are sufficient, and for benign PT, a negative margin may not be necessary. METHODS: We performed an 11-institution contemporary (2007-2017) review of PT practices. Demographics, surgical, and histopathologic data were captured. Logistic regression was used to estimate the association of select covariates with local recurrence (LR). RESULTS: Of 550 PT patients, the majority underwent excisional biopsy (55.3%, n = 302/546) or lumpectomy (wide excision) (38.5%, n = 210/546). Median tumor size was 30 mm, 68.9% (n = 379) were benign, 19.6% (n = 108) borderline, and 10.5% (n = 58) malignant. Surgical margins were positive in 42% (n = 231) and negative in 57.3% (n = 311). A second operation was performed in 38.0% (n = 209) of the total cohort, including 51 patients with an initial negative margin (82.4% with < 2 mm), and 157 with an initial positive margin, with residual disease only found in six (2.9%). Notably, 32.0% (n = 74) of those with an initial positive margin did not undergo a second operation, among whom only 2.7% (n = 2) recurred. Recurrence occurred in 3.3% (n = 18) of the total cohort (n = 15 LR, n = 3 distant), at median follow-up of 36.7 months. LR (all PT grades) was not reduced with wider negative margin width (≥ 2 mm v < 2 mm: odds ratio [OR] = 0.39; 95% CI, 0.07 to 2.10; P = .27) or final margin status (positive v negative: OR = 0.96; 95% CI, 0.26 to 3.52; P = .96). CONCLUSION: In current practice, many patients are managed outside of current guidelines. For the entire cohort, a wider margin width was not associated with a reduced risk of LR. We do not recommend re-excision of a negative margin for benign PT, regardless of margin width, as a progressively wider surgical margin is unlikely to reduce LR.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

January 20, 2021

Volume

39

Issue

3

Start / End Page

178 / 189

Location

United States

Related Subject Headings

  • United States
  • Tumor Burden
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Practice Guidelines as Topic
  • Phyllodes Tumor
  • Oncology & Carcinogenesis
 

Citation

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Rosenberger, L. H., Thomas, S. M., Nimbkar, S. N., Hieken, T. J., Ludwig, K. K., Jacobs, L. K., … Jakub, J. W. (2021). Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines. J Clin Oncol, 39(3), 178–189. https://doi.org/10.1200/JCO.20.02647
Rosenberger, Laura H., Samantha M. Thomas, Suniti N. Nimbkar, Tina J. Hieken, Kandice K. Ludwig, Lisa K. Jacobs, Megan E. Miller, et al. “Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines.J Clin Oncol 39, no. 3 (January 20, 2021): 178–89. https://doi.org/10.1200/JCO.20.02647.
Rosenberger LH, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, et al. Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines. J Clin Oncol. 2021 Jan 20;39(3):178–89.
Rosenberger, Laura H., et al. “Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines.J Clin Oncol, vol. 39, no. 3, Jan. 2021, pp. 178–89. Pubmed, doi:10.1200/JCO.20.02647.
Rosenberger LH, Thomas SM, Nimbkar SN, Hieken TJ, Ludwig KK, Jacobs LK, Miller ME, Gallagher KK, Wong J, Neuman HB, Tseng J, Hassinger TE, King TA, Jakub JW. Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines. J Clin Oncol. 2021 Jan 20;39(3):178–189.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

January 20, 2021

Volume

39

Issue

3

Start / End Page

178 / 189

Location

United States

Related Subject Headings

  • United States
  • Tumor Burden
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Practice Guidelines as Topic
  • Phyllodes Tumor
  • Oncology & Carcinogenesis