Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May;125(6):947-957.
doi: 10.1002/jso.26820. Epub 2022 Feb 18.

Malignant phyllodes tumor and primary breast sarcoma; distinct rare tumors of the breast

Lily Gutnik  1 , Yi Ren  2   3 , Samantha M Thomas  2   3 , Jennifer K Plichta  2   4 , Rachel A Greenup  5 , Oluwadamilola M Fayanju  6 , E Shelley Hwang  2   4 , Laura H Rosenberger  2   4
Affiliations

Malignant phyllodes tumor and primary breast sarcoma; distinct rare tumors of the breast

Lily Gutnik et al. J Surg Oncol. 2022 May.

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.

Keywords: breast; outcomes; overall survival; phyllodes; sarcoma.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Patient Flow Diagram (NCDB 2016 dataset)
Figure 2:
Figure 2:
Kaplan-Meier Curve of Unadjusted Overall Survival for Malignant Phyllodes and Primary Breast Sarcoma
See this image and copyright information in PMC

References

    1. Adem C, Reynolds C, Ingle JN, Nascimento AG. Primary breast sarcoma: clinicopathologic series from the Mayo Clinic and review of the literature. Br J Cancer. 2004;91:237–41. - PMC - PubMed
    1. Bousquet G, Confavreux C, Magné N, de Lara CT, Poortmans P, Senkus E, et al. Outcome and prognostic factors in breast sarcoma: a multicenter study from the rare cancer network. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2007;85:355–61. - PubMed
    1. Kirova YM, Vilcoq JR, Asselain B, Sastre-Garau X, Fourquet A. Radiation-induced sarcomas after radiotherapy for breast carcinoma: a large-scale single-institution review. Cancer. 2005;104:856–63. - PubMed
    1. Holm M, Aggerholm-Pedersen N, Mele M, Jørgensen P, Baerentzen S, Safwat A. Primary breast sarcoma: A retrospective study over 35 years from a single institution. Acta Oncologica. 2016;55:584–90. - PubMed
    1. Voutsadakis IA, Zaman K, Leyvraz S. Breast sarcomas: current and future perspectives. Breast (Edinburgh, Scotland). 2011;20:199–204. - PubMed