Clinico-Pathological Factors Determining Recurrence of Phyllodes Tumors of the Breast: The 25-Year Experience at a Tertiary Cancer Centre

Abstract

Background: Phyllodes tumors (PTs) of the breast are rare fibroepithelial tumors that are generally more prone to recurrence. Aims and objectives: This study aimed to assess the clinicopathological features, diagnostic modalities, and therapeutic interventions, along with their respective outcomes, to identify the factors associated with a recurrence of PTs of the breast. Methodology: A retrospective cohort and observational study was conducted, which entailed analyzing the clinicopathological data of patients who were previously diagnosed or presented with PTs of the breast between 1996 and 2021. Data included the total number of patients diagnosed with PTs of the breast and their ages, tumor grade on initial biopsy, tumor location (left or right breast), tumor size, therapeutic interventions carried out (including surgery—either mastectomy or lumpectomy—and adjuvant radiotherapy), final tumor grade, recurrence status, type of recurrence, and time to recurrence. Results: We analyzed data on a total of 87 patients who were pathologically proven to have PTs, and 46 patients (52.87%) were found to have recurrences. All patients were female, with a mean age at diagnosis of 39 years (range 15–70). Patients aged <40 years had the highest incidence of recurrence, with a rate of 54.35% (n = 25/46), followed by patients aged >40 years, with a rate of recurrence of 45.65% (n = 21/46). A total of 55.4% of patients presented with primary PTs and 44.6% had recurrent PTs at presentation. The average time to local recurrence (LR) from the completion of treatment was 13.8 months, whereas for systemic recurrence (SR), it was 15.29 months. Surgery (mastectomy/lumpectomy) was the major determinant for local recurrence (p < 0.05). Conclusion: Patients who received adjuvant radiotherapy (RT) had a minimal recurrence of PTs. Patients who were found to have a malignant biopsy on initial diagnosis (triple assessment) had a higher incidence of PTs and were more prone to SR than LR. Surgery was a determining factor in the increased rate of LR, with lumpectomy associated with a higher incidence of LR than mastectomy.

Clinicopathological Parameters Predicting Malignancy in Phyllodes Tumor of the Breast

“…PT encompasses a wide range of fibroepithelial diseases ranging from relatively indolent, benign neoplasms to malignant tumors that have the potential to progress rapidly and metastasize [5]. Distant metastasis is a feature exclusive to malignant PTs, with the lungs (66%) and bones (28%) being the most common sites of metastasis [6]. The World Health Organization (WHO) classified PTs into three categories, namely, benign, borderline, and malignant, on the basis of five prognostically important morphological features: stromal overgrowth, stromal atypia, tumor cellularity, mitotic count, and tumor margins [7].…”