Phyllodes Tumor of the Breast: Stromal Overgrowth and
Histological Classification are Useful Prognosis-predictive Factors
for Local Recurrence in Patients with a Positive Surgical Margin
Naruto Taira1, Daisuke Takabatake1, Kenjiro Aogi1, Shozo Ohsumi1, Shigemitsu Takashima1, Rieko Nishimura2
and Norihiro Teramoto2
1Departments of Surgery, National Hospital Organization, National Shikoku Cancer Center, 160 Kou
Minamiumemoto-machi, Matsuyama-city, Ehime 791-1288, Japan and2Departments of Pathology,
National Hospital Organization, National Shikoku Cancer Center, 160 Kou Minamiumemoto-machi,
Matsuyama-city, Ehime 791-1288, Japan
Received March 23, 2007; accepted June 16, 2007; published online October 11, 2007
Background: The local recurrence rate of phyllodes tumors is high and ensuring a sufficient
surgical margin is considered important for local control. However, the preoperative diagnosis
rate of phyllodes tumors is low and we often encounter cases in which a sufficient surgical
margin is not achieved, since in routine medical practice the lesion may not be diagnosed as
phyllodes tumor until postoperative biopsy of a mammary mass. Furthermore, there are no
established therapeutic guidelines for surgical stump-positive phyllodes tumors. We reviewed
the outcomes of excision of phyllodes tumors to investigate factors involved in local recur-
rence and to determine the indication for re-excision in stump-positive cases.
Methods: The subjects were 45 patients treated for phyllodes tumors at our institution from
January 1980 to July 2005. Age, tumor size, surgical method, stromal cellular atypia, mitotic
activity, stromal overgrowth, histological classification and surgical stump status were analyzed.
Results: Median age was 45 years old (range 28–75) and tumor size was 1–17 cm (median
3.5 cm). Pathologic diagnoses were benign, borderline and malignant in 31, five and nine
cases, respectively, and the surgical stump was negative in 27 lesions and positive in 15.
Median follow-up was 101 months (range 1–273), with local recurrence in six cases and
distant metastasis in one. The local recurrence-free rate was 88, 88 and 84% and the
disease-free rate was 85, 85 and 81% after 5, 10 and 15 years, respectively. Overall 10-year
survival was 97%. In univariate analysis, a positive surgical margin, stromal overgrowth and
histological classification were predictive factors for local recurrence after breast-conservation
surgery (P ¼ 0.0034, 0.0003, 0.026). A positive surgical stump was the only independent pre-
dictor of local recurrence in multivariate analysis (RR 0.086; 95% CI 0.01–0.743, P ¼ 0.012).
Stromal overgrowth was a predictive factor for local recurrence in cases with a positive
surgical margin (P ¼ 0.0139).
Conclusion: Wide excision is the preferred therapy for phyllodes tumor and preoperative
diagnosis is important for good local control. Re-excision is recommended in cases with a
positive surgical margin and stromal overgrowth and malignancy.
Key words: phyllodes tumor – cystosarcoma phyllodes – breast tumor
Surgery has been the primary mode of treatment of phyl-
lodes tumor, with mastectomy being the common treatment
of choice. However, surgery in which the breast is conserved
has become increasingly common in management of phyl-
lodes tumors for cosmetic reasons. There is a relatively high
incidence of local recurrence associated with phyllodes
tumors, and age, tumor size, surgical approach, mitotic
activity, stromal overgrowth and surgical margin have been
reported as prognosis-predictive factors related to local
For reprints and all correspondence: N. Taira, Dentistry Pharmaceutical
Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata,
Okayama 700-8558, Japan. E-mail: firstname.lastname@example.org
# 2007 Foundation for Promotion of Cancer Research
Jpn J Clin Oncol 2007;37(10)730–736
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