Marie-José Adam1, Sofiane Bendifallah2, Négar Kalhorpour2, Camille Cohen-Steiner3, Laetitia Ropars4, Asma Mahmood5, Chloé Rousseau6, Jean Leveque7, Krystel Nyangoh Timoh1, Adolphe Der Some8, Lobna Ouldamer3, Guillaume Legendre4, Marcos Ballester2, Emile Daraï2, Geoffroy Canlorbe5, Vincent Lavoue9. 1. Service de Gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000, Rennes, France; Service de Sénologie, CRLC Eugène Marquis, Avenue de Bataille Flandres Dunkerque, 35000, Rennes, France. 2. Service de Gynécologie, CHU de Tenon, Assistance Publique des Hôpitaux de Paris, 4 Rue de la Chine, 75020, Paris, France. 3. Service de Gynécologie, CHU de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France. 4. Service de Gynécologie, CHU d'Angers, 4 Rue Larrey, 49100, Angers, France. 5. Service de Gynécologie, CHU La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. 6. Service de Pharmacologie Clinique, CIC Inserm 1414, CHU de Rennes, Hôpital Pontchaillou, 2, rue Henri Le Guilloux, 35033, Rennes, France. 7. Service de Gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000, Rennes, France; Service de Sénologie, CRLC Eugène Marquis, Avenue de Bataille Flandres Dunkerque, 35000, Rennes, France; INSERM 1242, Chemistry, Oncogenesis, Stress and Signaling, Rennes, France. 8. Service de Gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000, Rennes, France. 9. Service de Gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000, Rennes, France; Service de Sénologie, CRLC Eugène Marquis, Avenue de Bataille Flandres Dunkerque, 35000, Rennes, France; INSERM 1242, Chemistry, Oncogenesis, Stress and Signaling, Rennes, France. Electronic address: vincent.lavoue@chu-rennes.fr.
Abstract
OBJECTIVE: 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 (borderline) or 3 (malignant) PT between 2000 and 2016 in five tertiary University hospitals, diagnosed according to World Health Organisation classification. RESULTS: 230 patients were included: 144 (63%), 60 (26%) and 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 less recurrence in all PT grades. For grade 1 PT, there was also significantly less recurrence with surgical margin >5 mm, (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 whatever 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.
OBJECTIVE: To assess prognostic factors of recurrence of phyllodestumors (PT) of the breast. METHODS: We performed a retrospective, multicentric cohort study, including all patients who underwent breast surgery for grade 1 (benign), 2 (borderline) or 3 (malignant) PT between 2000 and 2016 in five tertiary University hospitals, diagnosed according to World Health Organisation classification. RESULTS: 230 patients were included: 144 (63%), 60 (26%) and 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 less recurrence in all PT grades. For grade 1 PT, there was also significantly less recurrence with surgical margin >5 mm, (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 whatever 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.
Authors: Elisabetta Di Liso; Michele Bottosso; Marcello Lo Mele; Vassilena Tsvetkova; Maria Vittoria Dieci; Federica Miglietta; Cristina Falci; Giovanni Faggioni; Giulia Tasca; Carlo Alberto Giorgi; Tommaso Giarratano; Eleonora Mioranza; Silvia Michieletto; Tania Saibene; Angelo Paolo Dei Tos; PierFranco Conte; Valentina Guarneri Journal: ESMO Open Date: 2020-10