Lily Gutnik1, Yi Ren2,3, Samantha M Thomas2,3, Jennifer K Plichta2,4, Rachel A Greenup5, Oluwadamilola M Fayanju6, E Shelley Hwang2,4, Laura H Rosenberger2,4. 1. Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. 2. Duke Cancer Institute, Duke University, Durham, North Carolina, USA. 3. Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA. 4. Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. 5. Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA. 6. Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract
BACKGROUND: Malignant phyllodes (MP) and primary breast sarcomas (PBS) are rare neoplasms with overlapping histopathologic features. We compared overall survival (OS) and estimated the association of surgery and therapies with OS. METHODS: We utilized the National Cancer Database (2004-2016). Patients without surgery, unknown surgery, or margins, or Stage IV disease were excluded. Kaplan-Meier curves and Cox proportional hazards models were used to estimate unadjusted and adjusted OS, respectively. RESULTS: A total of 3209 (59.5%) MP, and 2185 (40.5%) PBS were identified. Despite a larger median tumor size in MP (46 vs. 40 mm PBS, p < 0.001), lumpectomy rate was higher for MP (52.9% vs. 27.0% PBS, p < 0.001). Compared to MP, PBS patients more frequently received radiation (28.9% vs. 24%), and chemotherapy (28.1% vs. 4%), both p < 0.001. Unadjusted OS was lower for PBS (57% vs. 85% MP, log-rank p < 0.001). PBS (vs. MP) had persistently worse survival (hazard ratio [HR]: 1.98, 95% confidence interval [CI]: 1.69-2.31) after adjustment. Receipt of adjuvant therapies was not associated with OS (either neoplasm); however, lumpectomy was associated with improved OS (vs. mastectomy) for both PBS (HR: 0.59, 95% CI: 0.50-0.75) and MP (HR: 0.65, 95% CI: 0.53-0.81). Positive margins had no association with OS for MP (HR: 1.09, 95% CI: 0.75-1.60), but was associated with worse survival for PBS (HR: 2.35, 95% CI: 1.82-3.02). DISCUSSION: We found significant survival differences between MP and PBS, with PBS having a consistently worse OS. Our findings support surgery as the mainstay of treatment for both tumor types and suggest that lumpectomy may be a reasonable option for select patients without compromising outcomes.
BACKGROUND: Malignant phyllodes (MP) and primary breast sarcomas (PBS) are rare neoplasms with overlapping histopathologic features. We compared overall survival (OS) and estimated the association of surgery and therapies with OS. METHODS: We utilized the National Cancer Database (2004-2016). Patients without surgery, unknown surgery, or margins, or Stage IV disease were excluded. Kaplan-Meier curves and Cox proportional hazards models were used to estimate unadjusted and adjusted OS, respectively. RESULTS: A total of 3209 (59.5%) MP, and 2185 (40.5%) PBS were identified. Despite a larger median tumor size in MP (46 vs. 40 mm PBS, p < 0.001), lumpectomy rate was higher for MP (52.9% vs. 27.0% PBS, p < 0.001). Compared to MP, PBS patients more frequently received radiation (28.9% vs. 24%), and chemotherapy (28.1% vs. 4%), both p < 0.001. Unadjusted OS was lower for PBS (57% vs. 85% MP, log-rank p < 0.001). PBS (vs. MP) had persistently worse survival (hazard ratio [HR]: 1.98, 95% confidence interval [CI]: 1.69-2.31) after adjustment. Receipt of adjuvant therapies was not associated with OS (either neoplasm); however, lumpectomy was associated with improved OS (vs. mastectomy) for both PBS (HR: 0.59, 95% CI: 0.50-0.75) and MP (HR: 0.65, 95% CI: 0.53-0.81). Positive margins had no association with OS for MP (HR: 1.09, 95% CI: 0.75-1.60), but was associated with worse survival for PBS (HR: 2.35, 95% CI: 1.82-3.02). DISCUSSION: We found significant survival differences between MP and PBS, with PBS having a consistently worse OS. Our findings support surgery as the mainstay of treatment for both tumor types and suggest that lumpectomy may be a reasonable option for select patients without compromising outcomes.
Authors: Sue Zann Lim; Cedric Chuan Young Ng; Vikneswari Rajasegaran; Peiyong Guan; Sathiyamoorthy Selvarajan; Aye Aye Thike; Nur Diyana Binte Md Nasir; Valerie Cui Yun Koh; Benita Kiat Tee Tan; Kong Wee Ong; Bin Tean Teh; Puay Hoon Tan Journal: Breast Cancer Res Treat Date: 2018-12-03 Impact factor: 4.872
Authors: Jerzy Mituś; Marian Reinfuss; Jerzy W Mituś; Jerzy Jakubowicz; Pawel Blecharz; Wojciech M Wysocki; Piotr Skotnicki Journal: Breast J Date: 2014-09-17 Impact factor: 2.431
Authors: Taiwo Adesoye; Heather B Neuman; Lee G Wilke; Jessica R Schumacher; Jennifer Steiman; Caprice C Greenberg Journal: Ann Surg Oncol Date: 2016-06-22 Impact factor: 5.344
Authors: Benjamin Y Tan; Geza Acs; Sophia K Apple; Sunil Badve; Ira J Bleiweiss; Edi Brogi; José P Calvo; David J Dabbs; Ian O Ellis; Vincenzo Eusebi; Gelareh Farshid; Stephen B Fox; Shu Ichihara; Sunil R Lakhani; Emad A Rakha; Jorge S Reis-Filho; Andrea L Richardson; Aysegul Sahin; Fernando C Schmitt; Stuart J Schnitt; Kalliopi P Siziopikou; Fernando A Soares; Gary M Tse; Anne Vincent-Salomon; Puay Hoon Tan Journal: Histopathology Date: 2016-01 Impact factor: 5.087