Mathias Neron1, Christophe Sajous2, Simon Thezenas3, Sophie Piperno-Neumann4, Fabien Reyal5, Marick Laé6, Camille Chakiba7, Audrey Michot8, Nicolas Penel9, Charles Honoré10, Clémentine Owen10, François Bertucci11, Sébastien Salas12, Esma Saada-Bouzid13, Thibaud Valentin14, Emmanuelle Bompas15, Mehdi Brahmi2, Isabelle Ray-Coquard2, Jean-Yves Blay2, Nelly Firmin16. 1. Department of Surgical Oncology, Institut du Cancer Montpellier (ICM), Univ Montpellier, Montpellier, France. mathias.neron@orange.fr. 2. Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard Lyon I, Lyon, France. 3. Department of Biostatistics, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France. 4. Department of Medical Oncology, Institut Curie, Paris, France. 5. Department of Surgical Oncology, Institut Curie, Paris, France. 6. Department of Pathology, Institut Curie, Paris, France. 7. Department of Medical Oncology, Institut Bergonié, Bordeaux, France. 8. Department of Surgical Oncology, Institut Bergonié, Bordeaux, France. 9. Department of Medical Oncology, Institut Oscar Lambret, Lille, France. 10. Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France. 11. Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France. 12. Department of Medical Oncology, CHU La Timone, Marseille, France. 13. Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France. 14. Department of Medical Oncology, IUCT Oncopole, Toulouse, France. 15. Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France. 16. Department of Medical Oncology, Institut du Cancer Montpellier, Univ Montpellier, Montpellier, France.
Abstract
BACKGROUND: The optimal threshold of surgical margins for breast malignant phyllodes tumors (MPTs) and the impact of adjuvant chemotherapy and radiotherapy were investigated. PATIENTS AND METHODS: We conducted a multicenter nationwide retrospective study of all MPT cases with central pathological review within the French Sarcoma Group. Endpoints were local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) rates. RESULTS: Overall, 212 patients were included in the study. All non-metastatic patients underwent primary surgical treatment, including 58.6% of conservative surgeries. An R0 resection was achieved in 117 patients (59.4%: 26.9% of patients with 1-2 mm margins, 12.2% of patients with 3-7 mm margins, 20.3% of patients with ≥ 8 mm margins). Ninety-four patients (45%) underwent a second surgery (SS) to obtain R0 margins, with a final mastectomy rate of 72.6%. Radiotherapy and chemotherapy were performed in 91 (43.1%) and 23 patients (10.9%), respectively, but were not associated with better outcomes. Mastectomy was significantly associated with better LRFS (p < 0.001). Margins of 0, 1, or 2 mm with SS were associated with better MFS (hazard ratio [HR] 0.3, p = 0.005) and OS (HR 0.32, p = 0.005) compared with margins of 0-1-2 mm without SS. Wider margins (> 8 mm) were not superior to margins of 3-7 mm (3-7 mm vs. > 8 mm; HR 0.81, p = 0.69). Age (HR 2.14, p = 0.038) and tumor necrosis (HR 1.96, p = 0.047) were found to be poor prognostic factors and were associated with MFS. CONCLUSIONS: This study suggests that 3 mm margins are necessary and sufficient for surgical management of MPTs, and emphasizes the importance of SS to obtain clear margins in case of 0-1-2 mm margins. No impact of adjuvant chemotherapy or radiotherapy was detected in this study.
BACKGROUND: The optimal threshold of surgical margins for breast malignant phyllodes tumors (MPTs) and the impact of adjuvant chemotherapy and radiotherapy were investigated. PATIENTS AND METHODS: We conducted a multicenter nationwide retrospective study of all MPT cases with central pathological review within the French Sarcoma Group. Endpoints were local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) rates. RESULTS: Overall, 212 patients were included in the study. All non-metastatic patients underwent primary surgical treatment, including 58.6% of conservative surgeries. An R0 resection was achieved in 117 patients (59.4%: 26.9% of patients with 1-2 mm margins, 12.2% of patients with 3-7 mm margins, 20.3% of patients with ≥ 8 mm margins). Ninety-four patients (45%) underwent a second surgery (SS) to obtain R0 margins, with a final mastectomy rate of 72.6%. Radiotherapy and chemotherapy were performed in 91 (43.1%) and 23 patients (10.9%), respectively, but were not associated with better outcomes. Mastectomy was significantly associated with better LRFS (p < 0.001). Margins of 0, 1, or 2 mm with SS were associated with better MFS (hazard ratio [HR] 0.3, p = 0.005) and OS (HR 0.32, p = 0.005) compared with margins of 0-1-2 mm without SS. Wider margins (> 8 mm) were not superior to margins of 3-7 mm (3-7 mm vs. > 8 mm; HR 0.81, p = 0.69). Age (HR 2.14, p = 0.038) and tumor necrosis (HR 1.96, p = 0.047) were found to be poor prognostic factors and were associated with MFS. CONCLUSIONS: This study suggests that 3 mm margins are necessary and sufficient for surgical management of MPTs, and emphasizes the importance of SS to obtain clear margins in case of 0-1-2 mm margins. No impact of adjuvant chemotherapy or radiotherapy was detected in this study.
Authors: Lily Gutnik; Yi Ren; Samantha M Thomas; Jennifer K Plichta; Rachel A Greenup; Oluwadamilola M Fayanju; E Shelley Hwang; Laura H Rosenberger Journal: J Surg Oncol Date: 2022-02-18 Impact factor: 3.454
Authors: Germana Lissidini; Antonino Mulè; Angela Santoro; Giovanni Papa; Luca Nicosia; Enrico Cassano; Arwa Ahmed Ashoor; Paolo Veronesi; Liron Pantanowitz; Jason L Hornick; Esther Diana Rossi Journal: Pathologica Date: 2022-04-13