The Characteristics of Local Recurrence After Breast-Conserving Surgery Alone for Malignant and Borderline Phyllodes Tumors of the Breast (KROG 16-08)

Noorie Choi, Kyubo Kim, Kyung Hwan Shin, Yumi Kim, Hyeong Gon Moon, Won Park, Doo Ho Choi, Su Ssan Kim, Seung Do Ahn, Tae Hyun Kim, Mison Chun, Yongbae Kim, Suzy Kim, Byung Ock Choi, Jin Hee Kim

Research output: Contribution to journalArticle

Abstract

Background: Despite margin-negative breast-conserving surgery (BCS), phyllodes tumors (PT) of the breast show high local recurrence (LR) rates. In this study we aimed to assess the site and grade of LR to identify high-risk patients after initial treatment of malignant and borderline PT using BCS alone. Patients and Methods: From 1981 to 2014, 312 patients with malignant (n = 164) and borderline (n = 148) PT were treated using BCS alone at 10 centers. LR was defined as true recurrence (TR) if < 2 cm from the primary tumor bed and as elsewhere failure (EF) if otherwise. Results: At a median of 21 months, LR occurred in 17.6% (55 of 312), 18.9% (31 of 164) among malignant and 16.2% (24 of 148) among borderline PT (P = .636). Only 1.9% (6 of 312) had EF. Five-year cumulative LR rates were 14.7% and 35.9% after margin-negative and -positive BCS, respectively (P < .001). Positive margin was an independent risk factor for TR (P = .002) and EF (P = .002). In multivariable competing risk regression of patients with negative margins < 1 cm (n = 115), age < 35 years (P = .001), and tumor size ≥ 5 cm (P = .008) independently increased LR risk. Of patients who experienced a LR, 30.9% (17 of 55) had a second or third repeated event. Borderline-to-malignant transformation rates increased at each LR event: 4.1% (6 of 148), 12.5% (3 of 24), and 77.8% (7 of 9) at first, second, and third LR, respectively (P = .006). Conclusion: LRs almost always develop near the primary tumor bed. Many patients experience multiple events, with heightened risk of borderline-to-malignant transformation at each subsequent event. For patients with negative margins < 1 cm, younger age and larger tumor size are independent risk factors for increased LR. Despite margin-negative breast-conserving surgery, malignant and borderline phyllodes tumors show frequent local recurrence. In this large-scale multicenter study we analyzed the characteristics of locally recurrent tumors after initial treatment with breast-conserving surgery alone. Local recurrences almost always occur near the primary tumor bed. Multiple events are relatively common, with each subsequent event showing increasing risk of borderline-to-malignant transformation.

Original languageEnglish
JournalClinical Breast Cancer
DOIs
Publication statusPublished - 2019 Jan 1

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Phyllodes Tumor
Segmental Mastectomy
Breast
Recurrence
Neoplasms

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Choi, Noorie ; Kim, Kyubo ; Shin, Kyung Hwan ; Kim, Yumi ; Moon, Hyeong Gon ; Park, Won ; Choi, Doo Ho ; Kim, Su Ssan ; Ahn, Seung Do ; Kim, Tae Hyun ; Chun, Mison ; Kim, Yongbae ; Kim, Suzy ; Choi, Byung Ock ; Kim, Jin Hee. / The Characteristics of Local Recurrence After Breast-Conserving Surgery Alone for Malignant and Borderline Phyllodes Tumors of the Breast (KROG 16-08). In: Clinical Breast Cancer. 2019.
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title = "The Characteristics of Local Recurrence After Breast-Conserving Surgery Alone for Malignant and Borderline Phyllodes Tumors of the Breast (KROG 16-08)",
abstract = "Background: Despite margin-negative breast-conserving surgery (BCS), phyllodes tumors (PT) of the breast show high local recurrence (LR) rates. In this study we aimed to assess the site and grade of LR to identify high-risk patients after initial treatment of malignant and borderline PT using BCS alone. Patients and Methods: From 1981 to 2014, 312 patients with malignant (n = 164) and borderline (n = 148) PT were treated using BCS alone at 10 centers. LR was defined as true recurrence (TR) if < 2 cm from the primary tumor bed and as elsewhere failure (EF) if otherwise. Results: At a median of 21 months, LR occurred in 17.6{\%} (55 of 312), 18.9{\%} (31 of 164) among malignant and 16.2{\%} (24 of 148) among borderline PT (P = .636). Only 1.9{\%} (6 of 312) had EF. Five-year cumulative LR rates were 14.7{\%} and 35.9{\%} after margin-negative and -positive BCS, respectively (P < .001). Positive margin was an independent risk factor for TR (P = .002) and EF (P = .002). In multivariable competing risk regression of patients with negative margins < 1 cm (n = 115), age < 35 years (P = .001), and tumor size ≥ 5 cm (P = .008) independently increased LR risk. Of patients who experienced a LR, 30.9{\%} (17 of 55) had a second or third repeated event. Borderline-to-malignant transformation rates increased at each LR event: 4.1{\%} (6 of 148), 12.5{\%} (3 of 24), and 77.8{\%} (7 of 9) at first, second, and third LR, respectively (P = .006). Conclusion: LRs almost always develop near the primary tumor bed. Many patients experience multiple events, with heightened risk of borderline-to-malignant transformation at each subsequent event. For patients with negative margins < 1 cm, younger age and larger tumor size are independent risk factors for increased LR. Despite margin-negative breast-conserving surgery, malignant and borderline phyllodes tumors show frequent local recurrence. In this large-scale multicenter study we analyzed the characteristics of locally recurrent tumors after initial treatment with breast-conserving surgery alone. Local recurrences almost always occur near the primary tumor bed. Multiple events are relatively common, with each subsequent event showing increasing risk of borderline-to-malignant transformation.",
author = "Noorie Choi and Kyubo Kim and Shin, {Kyung Hwan} and Yumi Kim and Moon, {Hyeong Gon} and Won Park and Choi, {Doo Ho} and Kim, {Su Ssan} and Ahn, {Seung Do} and Kim, {Tae Hyun} and Mison Chun and Yongbae Kim and Suzy Kim and Choi, {Byung Ock} and Kim, {Jin Hee}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.clbc.2019.04.003",
language = "English",
journal = "Clinical Breast Cancer",
issn = "1526-8209",
publisher = "Elsevier",

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The Characteristics of Local Recurrence After Breast-Conserving Surgery Alone for Malignant and Borderline Phyllodes Tumors of the Breast (KROG 16-08). / Choi, Noorie; Kim, Kyubo; Shin, Kyung Hwan; Kim, Yumi; Moon, Hyeong Gon; Park, Won; Choi, Doo Ho; Kim, Su Ssan; Ahn, Seung Do; Kim, Tae Hyun; Chun, Mison; Kim, Yongbae; Kim, Suzy; Choi, Byung Ock; Kim, Jin Hee.

In: Clinical Breast Cancer, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The Characteristics of Local Recurrence After Breast-Conserving Surgery Alone for Malignant and Borderline Phyllodes Tumors of the Breast (KROG 16-08)

AU - Choi, Noorie

AU - Kim, Kyubo

AU - Shin, Kyung Hwan

AU - Kim, Yumi

AU - Moon, Hyeong Gon

AU - Park, Won

AU - Choi, Doo Ho

AU - Kim, Su Ssan

AU - Ahn, Seung Do

AU - Kim, Tae Hyun

AU - Chun, Mison

AU - Kim, Yongbae

AU - Kim, Suzy

AU - Choi, Byung Ock

AU - Kim, Jin Hee

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Despite margin-negative breast-conserving surgery (BCS), phyllodes tumors (PT) of the breast show high local recurrence (LR) rates. In this study we aimed to assess the site and grade of LR to identify high-risk patients after initial treatment of malignant and borderline PT using BCS alone. Patients and Methods: From 1981 to 2014, 312 patients with malignant (n = 164) and borderline (n = 148) PT were treated using BCS alone at 10 centers. LR was defined as true recurrence (TR) if < 2 cm from the primary tumor bed and as elsewhere failure (EF) if otherwise. Results: At a median of 21 months, LR occurred in 17.6% (55 of 312), 18.9% (31 of 164) among malignant and 16.2% (24 of 148) among borderline PT (P = .636). Only 1.9% (6 of 312) had EF. Five-year cumulative LR rates were 14.7% and 35.9% after margin-negative and -positive BCS, respectively (P < .001). Positive margin was an independent risk factor for TR (P = .002) and EF (P = .002). In multivariable competing risk regression of patients with negative margins < 1 cm (n = 115), age < 35 years (P = .001), and tumor size ≥ 5 cm (P = .008) independently increased LR risk. Of patients who experienced a LR, 30.9% (17 of 55) had a second or third repeated event. Borderline-to-malignant transformation rates increased at each LR event: 4.1% (6 of 148), 12.5% (3 of 24), and 77.8% (7 of 9) at first, second, and third LR, respectively (P = .006). Conclusion: LRs almost always develop near the primary tumor bed. Many patients experience multiple events, with heightened risk of borderline-to-malignant transformation at each subsequent event. For patients with negative margins < 1 cm, younger age and larger tumor size are independent risk factors for increased LR. Despite margin-negative breast-conserving surgery, malignant and borderline phyllodes tumors show frequent local recurrence. In this large-scale multicenter study we analyzed the characteristics of locally recurrent tumors after initial treatment with breast-conserving surgery alone. Local recurrences almost always occur near the primary tumor bed. Multiple events are relatively common, with each subsequent event showing increasing risk of borderline-to-malignant transformation.

AB - Background: Despite margin-negative breast-conserving surgery (BCS), phyllodes tumors (PT) of the breast show high local recurrence (LR) rates. In this study we aimed to assess the site and grade of LR to identify high-risk patients after initial treatment of malignant and borderline PT using BCS alone. Patients and Methods: From 1981 to 2014, 312 patients with malignant (n = 164) and borderline (n = 148) PT were treated using BCS alone at 10 centers. LR was defined as true recurrence (TR) if < 2 cm from the primary tumor bed and as elsewhere failure (EF) if otherwise. Results: At a median of 21 months, LR occurred in 17.6% (55 of 312), 18.9% (31 of 164) among malignant and 16.2% (24 of 148) among borderline PT (P = .636). Only 1.9% (6 of 312) had EF. Five-year cumulative LR rates were 14.7% and 35.9% after margin-negative and -positive BCS, respectively (P < .001). Positive margin was an independent risk factor for TR (P = .002) and EF (P = .002). In multivariable competing risk regression of patients with negative margins < 1 cm (n = 115), age < 35 years (P = .001), and tumor size ≥ 5 cm (P = .008) independently increased LR risk. Of patients who experienced a LR, 30.9% (17 of 55) had a second or third repeated event. Borderline-to-malignant transformation rates increased at each LR event: 4.1% (6 of 148), 12.5% (3 of 24), and 77.8% (7 of 9) at first, second, and third LR, respectively (P = .006). Conclusion: LRs almost always develop near the primary tumor bed. Many patients experience multiple events, with heightened risk of borderline-to-malignant transformation at each subsequent event. For patients with negative margins < 1 cm, younger age and larger tumor size are independent risk factors for increased LR. Despite margin-negative breast-conserving surgery, malignant and borderline phyllodes tumors show frequent local recurrence. In this large-scale multicenter study we analyzed the characteristics of locally recurrent tumors after initial treatment with breast-conserving surgery alone. Local recurrences almost always occur near the primary tumor bed. Multiple events are relatively common, with each subsequent event showing increasing risk of borderline-to-malignant transformation.

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DO - 10.1016/j.clbc.2019.04.003

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SN - 1526-8209

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