Time to revise classification of phyllodes tumors of breast? Results of a French multicentric study

Abstract : To assess prognostic factors of recurrence of phyllodes tumors (PT) of the breast.Methods : We performed a retrospective, multicentric cohort study, including all patients who underwent breast surgery for grade 1 (benign), 2 (b orderline) or 3 (malignant) PT between 2000 and 2016 in five tertiary University hospitals, diagnosed according to World Health Organization classification. Results : 230 patients were included: 144 (63%), 60 (26%) an d 26 (11%) with grade 1, 2 and 3 PT, respectively. Recurrence occurred in 10 (7%), 7 (12%) and 5 (19%) patients with grade 1, 2 and 3 PT, respectively. In univariate analysis, moderate to severe nuclear stromal pleomorphism (HR 8.00 [95% CI: 1.65 - 38.73], p<0.009) was correlated with recurrence in all groups including grade 1 (HR 14.3 [95% CI: 1.29 - 160], p=0.031). In multivariate analysis, surgical margin >5 mm, (HR 0.20 [ 95% CI: 0.06 - 0.63 ] , p = 0.013) were significantly correlated with les s recurrence in all PT grades. For grade 1 PT, there was also significantly less recurrence with surgical margin >5mm, (HR 0.09 [95% CI: 0.01 - 0.85], p=0.047) in multivariate analysis. Conclusion : . The surgical margin should be at least 5 mm whate ver the grade of PT. Moderate to severe nuclear stromal pleomorphism identified a subgroup of grade 1 PT with a higher rate of recurrence. This suggests that the WHO classification could be revised with the introduction of nuclear stromal pleomorphism to tailor PT management
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Marie-José Adam, Sofiane Bendifallah, Négar Kalhorpour, Camille Cohen-Steiner, Laetitia Ropars, et al.. Time to revise classification of phyllodes tumors of breast? Results of a French multicentric study. EJSO - European Journal of Surgical Oncology, WB Saunders, 2018, 44 (11), pp.1743-1749. ⟨10.1016/j.ejso.2018.08.007⟩. ⟨hal-01880076⟩

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