良性和边缘性鳞状上皮肿瘤的切除缘宽度≥1 厘米对减少复发有必要吗?

IF 1.9 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Nattakarn Changchit, Natthawadee Laokulrath, Pradit Rushatamukayanunt, Pongthep Pisarnturakit
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引用次数: 0

摘要

背景。鳞状上皮肿瘤(PTs)是乳腺纤维上皮肿瘤,目前的治疗指南建议广泛切除,使手术切缘≥1厘米,以最大限度地降低复发风险。然而,核心活检标本的诊断难题往往导致手术切缘不理想。本研究旨在阐明边缘状态与 PT 复发之间的相关性,从而为手术决策提供依据,提高患者的治疗效果。方法。这项单中心回顾性研究回顾了 2011 年至 2018 年间被诊断为 PT 的泰国女性的病历,收集了有关人口统计学、临床表现、手术方法、肿瘤分级、大小和边缘状态的数据。主要终点是复发。结果。在分析的165例PT病例中,49.1%为边缘性,38.2%为良性,12.7%为恶性,中位随访4.5年,总复发率为13.9%(n = 23)。切除边缘<1厘米(从<1毫米到9毫米不等)阴性的患者与切除边缘≥1厘米的患者相比,复发率无明显差异(10.2% vs. 7.1%,p = 1.00)。值得注意的是,在切除边缘<1厘米阴性组中,边缘<1毫米(近边缘)与1-9毫米边缘相比,复发率明显更高(17.0% vs. 4.9%,p = 0.04)。边缘PT的复发率与总体趋势一致,而良性PT的复发率则随着边缘阳性而增加。多变量分析表明,边缘<1 mm与复发之间存在显著关联(调整后HR = 10.78 (95% CI 1.32-88.07),p = 0.027),凸显出边缘阳性范围越广,复发风险越高。结论我们的研究结果表明,对于良性和边缘型 PT,≥1 厘米的宽手术切缘可能不是防止复发的必要条件。值得注意的是,手术切缘窄于 1 毫米会大大增加边缘型 PT 复发的可能性。此外,手术切缘呈阳性与良性 PT 复发率增加有关。这些研究结果突出表明,在确定手术切缘时亟需一种专门针对 PT 类型的战略性方法,以有效提高患者的治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Is the ≥1 cm Width of the Resection Margin in Benign and Borderline Phyllodes Tumor Necessary to Reduce Recurrence?

Is the ≥1 cm Width of the Resection Margin in Benign and Borderline Phyllodes Tumor Necessary to Reduce Recurrence?

Background. Phyllodes tumors (PTs) are fibroepithelial neoplasms of the breast, with current treatment guidelines recommending wide excision to achieve surgical margins of ≥1 cm to minimize the recurrence risk. However, diagnostic challenges with core biopsy specimens often result in suboptimal surgical margins. This study aims to elucidate the correlation between margin status and PT recurrence, thereby informing surgical decision-making and enhancing patient outcomes. Methods. This single-center, retrospective study reviewed records of Thai women diagnosed with PTs between 2011 and 2018, collecting data on demographics, clinical presentation, surgical approach, tumor grade, size, and margin status. The primary endpoint was recurrence. Results. Among 165 PT cases analyzed—49.1% borderline, 38.2% benign, and 12.7% malignant—the overall recurrence rate was 13.9% (n = 23) over a median follow-up of 4.5 years. No significant difference in recurrence rates was observed between patients with negative resection margins <1 cm (ranging from <1 mm to 9 mm) compared to those with ≥1 cm (10.2% vs. 7.1%, p = 1.00). Notably, in negative resection margins <1 cm group, a margin <1 mm (close margin) was associated with a significantly higher recurrence rate compared to margins of 1–9 mm (17.0% vs. 4.9%, p = 0.04). Borderline PTs followed the overall trend, while benign PTs showed increased recurrence with positive margins. Multivariate analysis indicated a significant association between margins <1 mm and recurrence (adjusted HR = 10.78 (95% CI 1.32–88.07), p = 0.027), highlighting an increased recurrence risk with more extensive positive margins. Conclusion. Our findings suggest that a wide surgical margin of ≥1 centimeter may not be necessary to prevent recurrence in benign and borderline PTs. Notably, surgical margins narrower than 1 millimeter substantially elevate the recurrence likelihood in cases of borderline PTs. Furthermore, the presence of positive surgical margins correlates with an increased recurrence rate in benign PTs. These findings highlight the critical need for a strategic approach in determining surgical margins, tailored specifically to the type of PT, to enhance patient outcomes effectively.

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来源期刊
Breast Journal
Breast Journal 医学-妇产科学
CiteScore
4.00
自引率
0.00%
发文量
47
审稿时长
4-8 weeks
期刊介绍: The Breast Journal is the first comprehensive, multidisciplinary source devoted exclusively to all facets of research, diagnosis, and treatment of breast disease. The Breast Journal encompasses the latest news and technologies from the many medical specialties concerned with breast disease care in order to address the disease within the context of an integrated breast health care. This editorial philosophy recognizes the special social, sexual, and psychological considerations that distinguish cancer, and breast cancer in particular, from other serious diseases. Topics specifically within the scope of The Breast Journal include: Risk Factors Prevention Early Detection Diagnosis and Therapy Psychological Issues Quality of Life Biology of Breast Cancer.
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