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. 2020 Oct;5(5):e000843.
doi: 10.1136/esmoopen-2020-000843.

Prognostic factors in phyllodes tumours of the breast: retrospective study on 166 consecutive cases

Elisabetta Di Liso  1 , Michele Bottosso  2 , Marcello Lo Mele  3 , Vassilena Tsvetkova  1 , Maria Vittoria Dieci  4 , Federica Miglietta  2 , Cristina Falci  2 , Giovanni Faggioni  2 , Giulia Tasca  2 , Carlo Alberto Giorgi  2 , Tommaso Giarratano  2 , Eleonora Mioranza  2 , Silvia Michieletto  5 , Tania Saibene  5 , Angelo Paolo Dei Tos  6 , PierFranco Conte  7 , Valentina Guarneri  7
Affiliations

Prognostic factors in phyllodes tumours of the breast: retrospective study on 166 consecutive cases

Elisabetta Di Liso et al. ESMO Open. 2020 Oct.

Abstract

Background: Phyllodes tumours (PTs) are rare fibroepithelial tumours accounting for <1% of all breast tumours. We assessed clinicopathological features and their prognostic effect in a single-institution patients' cohort.

Methods: Patients diagnosed with PT between 2001 and 2018 at our institution were identified. Clinical, surgical and pathological features were collected. Phyllodes-related relapse was defined as locoregional or distant recurrence (contralateral excluded), whichever first.

Results: A total of 166 patients were included: 115 with benign, 30 with borderline and 21 with malignant PTs. Features associated with malignant PT were younger age, larger T size, higher mitotic count, marked cytological atypia, stromal overgrowth, stromal hypercellularity, necrosis and heterologous differentiation (all p<0.01). The majority of patients with malignant PT underwent mastectomy (63.2% vs 3% of benign/borderline, p<0.001) and had negative surgical margins (83.3%). 4-year cumulative phyllodes-related relapse incidence was 7% for benign/borderline PT and 21.3% for malignant PT (p=0.107). In the entire cohort, marked cellular atypia and heterologous differentiation were associated with worse phyllodes-related relapse-free survival (HR 14.10, p=0.036 for marked vs mild atypia; HR 4.21, p=0.031 for heterologous differentiation present vs absent). For patients with benign PT, larger tumour size was associated with worse phyllodes-related relapse-free survival (HR 9.67, p=0.013 for T>5 cm vs T≤2 cm). Higher tumour-infiltrating lymphocytes (TILs) were associated with borderline and malignant PT (p=0.023); TILs were not associated with phyllodes-related relapse-free survival (HR 0.58, p=0.361 for TILs>2% vs≤2%). Overall, four patients died because of PT: three patients with malignant and one with borderline PT.

Conclusions: Patients with malignant PT had increased rates of phyllodes-related relapse and phyllodes-related death. Cellular atypia and heterologous differentiation were poor prognostic factors in the entire cohort; large tumour size was associated with an increased risk of phyllodes-related relapse in benign PT.

Keywords: breast; histological classification; phyllodes tumours; phyllodes-related death; phyllodes-related recurrence.

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Conflict of interest statement

Competing interests: MVD declares personal fees for consulting/advisory board from Eli Lilly, Celgene and Genomic Health. APDT declares personal fees for advisory boards/speaker’s bureau from PharaMAr, Lilly, Roche, Bayer and Pfizer. PFC reports grants (Institution) from Agenzia Italiana del Farmaco AIFA, Merck KGa and BMS; personal fees for consulting/advisory board from Novartis, EliLilly, AstraZeneca, Tesaro and Roche. VG reports grants (institution) and personal fees for consulting/advisor from Roche; personal fees for consulting/advisory relationship from Novartis and Eli Lilly. All the disclosures are outside the submitted work. All other authors declared no conflicts of interest.

Figures

Figure 1
Figure 1
Cumulative incidence of phyllodes-related relapse according to PT grade: benign, borderline and malignant PT (A); benign/borderline and malignant (B); cumulative incidence of phyllodes-related death according to PT grade (C). PT, phyllodes tumour.
See this image and copyright information in PMC

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