Mammary phyllodes tumour: a 15-year multicentre clinical review

2017 ◽  
Vol 71 (6) ◽  
pp. 493-497 ◽  
Author(s):  
Michael Co ◽  
Clement Chen ◽  
Julia Y Tsang ◽  
Gary Tse ◽  
Ava Kwong
Keyword(s):  
Risk Factors ◽  
Local Recurrence ◽  
Tumour Size ◽  
Significant Risk ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Positive Surgical Margin ◽  
Biological Behaviour ◽  
Phyllodes Tumour ◽  
Long Term Prognosis

AimsPhyllodes tumour (PT) is an uncommon fibroepithelial tumour of the breast. It has a spectrum of aggressiveness in biological behaviour with chance of local recurrence and, occasionally, metastasis.MethodsA 15-year retrospective review from a multicentre database in Hong Kong was performed.ResultsClinical and pathological records of 465 patients with 469 PTs between 1998 and 2014 were reviewed. Median age of occurrence was 44 years (range 12–86 years). 281 (59.9%) PTs were benign, 124 (26.4%) were borderline and 64 (13.6%) were malignant. About half of all PTs (239, 51.5%) were between 2 and 5 cm while another 186 (40.1%) were >5 cm in size. Most PT (84.6%) were radiologically benign. Breast-conserving surgery (BCS) was feasible in 384 (82%) patients, whereas 84 (18%) patients had mastectomy. Multivariate analysis found that positive surgical margin (P<0.001) and BCS (P<0.001) were the only significant risk factors for local recurrence, while large tumour size (P=0.008) and malignant PT histotype (P<0.001) were the only significant risk factors for metastasis. Long-term prognosis of benign and borderline PT was excellent. After median follow-up interval of 85 months (range 12–180 months), the disease-specific survival of benign, borderline and malignant PT were 99.6%, 100% and 90.6%, respectively.ConclusionsLocal recurrence of PTs occurs irrespective of the tumour grade. Surgical margin is the only amendable factor to reduce the chance of recurrence.

The effect of margin status on local recurrence following breast conservation and radiation therapy for DCIS

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 597-597
Author(s):  
M. R. Kell ◽  
C. Dunne ◽  
C. Canning ◽  
M. Morrow
Keyword(s):  
Local Recurrence ◽  
Randomized Trials ◽  
Ductal Carcinoma ◽  
Breast Conservation ◽  
Significant Risk ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Surgical Margins ◽  
Significant Difference

597 Background: There is no consensus on what constitutes an adequate surgical margin in patients receiving breast conserving surgery (BCS) and postoperative irradiation (RT) for ductal carcinoma in situ (DCIS). Inadequate margins may result in high local recurrence, and excessively large resections may lead to poor cosmetic outcome without oncological benefit. Methods: A comprehensive search for published trials which examined outcomes after adjuvant RT following BCS for DCIS was performed using medline and cross referencing available data. Reviews of each study were conducted, and data were extracted. Fixed and random effects methods were used to combine data. Primary outcomes were in breast tumour recurrence (IBTR) related to surgical margins. Results: Analysis of 3,606 patients from randomized trials confirms that patients with negative margins are significantly less likely to recur than those with positive margins after RT (RR 0.53, 95% CI= 0.42 to 0.66, p<0.01). Combined data from randomized and non randomized trials, of 5,500 patients, demonstrates that where the margin status is close or unknown there is significant risk of IBTR compared to a negative margin (RR=1.68, 95% CI= 1.22–2.33, p<0.01). When specific margin thresholds are examined a 2 mm margin is superior to less than 2 mm (OR=0.67, 95% CI 0.51 -0.89, p<0.01), however we saw no significant difference in the rate of IBTR between a 2 mm margin and >5 mm (OR=1.49, 95% CI 0.54 to 4.9, p>0.05). Conclusions: Surgical margins negative for DCIS should be obtained following BCS for DCIS. A margin threshold of 2mm appears be as good as a larger margin when BCS for DCIS is combined with RT. No significant financial relationships to disclose.

Risk Factors of Stomal Recurrence After Laryngectomy: A Systematic Review and Meta-analysis

2017 ◽  
Vol 126 (9) ◽  
pp. 654-668 ◽  
Author(s):  
Jinyu Mei ◽  
Zhaohui Huang ◽  
Kaile Wu ◽  
Yi Zhao ◽  
Jianming Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Local Recurrence ◽  
Recurrence Rate ◽  
Postoperative Radiotherapy ◽  
Meta Analysis ◽  
Surgical Margin ◽  
Epidemiological Studies ◽  
Cochrane Library ◽  
Positive Surgical Margin ◽  
T Classification

Objective: We wished to investigate the risk factors for stoma recurrence following laryngectomy. Methods: PubMed, Cochrane Library, and Embase were searched to identify primary research studies published between January 1, 1967, and October 31, 2016. We only included observational epidemiological studies and used risk ratios (RRs) and 95% confidence intervals (CI) to summarize the primary risk factors associated with recurrence following laryngectomy. Results: A total of 44 articles, including 11 928 patients, were included in the current meta-analysis. The pooled estimates of the stomal recurrence rate and the local recurrence rate following laryngectomy were 6.60% (95% CI, 5.40-7.90) and 19.40% (95% CI, 14.00%-24.80%), respectively. For stomal recurrence, we confirmed a series of earlier identified factors, including tumor site, prior tracheotomy, tracheotomy timing, T-classification, lymph node metastases, postoperative pharyngoperistomal fistula, and a positive surgical margin. For local recurrence, postoperative radiotherapy, overexpression of p53, and overexpression of p21 were significant, while preoperative tracheostomy and postoperative pharyngoperistomal fistula had an unexpectedly low impact on risk. Conclusion: This study has confirmed a series of earlier identified factors for stomal recurrence and local recurrence following laryngectomy. Our results will provide important insights for clinical practice.

scholarly journals Risk factors for loco-regional recurrence after breast conserving surgery: impact of young age and surgical margin status in breast cancer patients

2018 ◽  
Vol 5 (9) ◽  
pp. 2952
Author(s):  
Mahtab Vasigh ◽  
Soodeh Rahmani ◽  
Ramesh Omranipour ◽  
Shahpar Haghighat ◽  
Ensiie Olfatbakhsh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Hormone Therapy ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Status ◽  
Regional Recurrence

Background: Breast cancer is a common malignant tumor and treatment predominantly consists of surgery.  Modern society has increased the demands of women to have higher requirements for breast appearance and quality of life. Therefore, exploring effective measures to control or reduce the rate of loco-regional recurrence (LRR) after breast conserving surgery (BCS) is the main focus of this study.Methods: This cohort included 743 consecutive patients with invasive breast cancer, treated with BCS in 2 centers in Tehran, Iran between 2005 and 2010. The primary endpoint was the rate of loco-regional recurrence in a 5-year follow- up period. Authors also investigated the factors that could predict LRR after BCS.Results: The prevalence of LRR after BCS was 7.6% in a median follow-up of 56.9 months. The Median time to local recurrence was 20.45 months.  A correlation between follow-up outcome and age; histologic sub-type; surgical margin; number of positive nodes; complete pathologic response to neo-adjuvant chemotherapy; chemotherapy and hormone therapy was recognized. Surgical margin status, hormone therapy, histologic sub-type, age and Ki67 were shown to be significant risk factors for LRR in univariate analysis whereas surgical margin status emerged as an independent risk factor in multivariate analysis.Conclusions: Increased LRR was observed among those with higher ki67, aged under35, not receiving hormone therapy and with a surgical margin less than 2mm. These factors appeared to be risk factors for LRR after BCS, while, histologic grade, axillary nodal status, tumor size and biologic sub-type did not predict LRR after BCS.

scholarly journals Local and Distant Recurrence in Resected Sacral Chordomas: A Systematic Review and Pooled Cohort Analysis

2018 ◽  
Vol 9 (2) ◽  
pp. 191-201 ◽  
Author(s):  
Daniel Kerekes ◽  
C. Rory Goodwin ◽  
A. Karim Ahmed ◽  
Jorrit-Jan Verlaan ◽  
Chetan Bettegowda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Prognostic Factors ◽  
Local Recurrence ◽  
Surgical Margin ◽  
Distant Recurrence ◽  
Population Characteristics ◽  
Significant Prognostic Factor ◽  
Close Monitoring ◽  
Sacral Chordoma

Study Design: Systematic review. Objectives: Sacral chordomas are rare, primary tumors of the spine, best treated with en bloc resection. The purpose of this study was to assess the literature for resected sacral chordoma and to quantify the prevalence of, risk factors for, and treatment outcomes of local and distant recurrence therein. Methods: We searched 5 online databases from January 1980 to May 2016 to find articles that report survival, recurrence outcomes, and/or prognostic factors for the resected sacral chordoma patient population. Characteristics and clinical outcomes of the pooled cohort are reported. Fisher exact tests, unpaired t tests, and one-way analysis of variance were used to investigate patient- and treatment-associated prognostic factors for local and distant recurrence. Survival analyses were performed for time to local recurrence and death. The protocol’s PROSPERO ID is CRD42015024384. Results: Fifty-seven studies, with 1235 unique sacral chordoma patients, were included in this review. Local and distant recurrence occurred in 42.6% and 22.4% of patients with adequate follow-up, respectively. Kaplan-Meier overall median survival for patients with and without recurrence were 98 and 209 months after surgery, respectively. Wide surgical margin was associated with a lower rate of local recurrence; and wide surgical margin, female sex, and patient age ≥65 years were associated with lower rates of distant recurrence. Conclusions: While surgical margin remains the most significant prognostic factor for local and distant recurrence, combined surgical approach may be associated with local recurrence. Male sex and age <65 years may be associated with distant recurrence. Patients with risk factors for recurrence should undergo close monitoring to maximize survival.

scholarly journals Approaches to phyllodes tumour of the breast: a review article

2017 ◽  
Vol 4 (3) ◽  
pp. 841 ◽  
Author(s):  
Firdaus Hayati ◽  
Ho Hui Lian ◽  
Nornazirah Azizan ◽  
Aishath Aznan Ali ◽  
Zainal Adwin Zainal Abidin ◽  
...  
Keyword(s):  
Surgical Margin ◽  
Asian Population ◽  
Preoperative Assessment ◽  
Positive Surgical Margin ◽  
Breast Pathology ◽  
Histologic Diagnosis ◽  
Triple Assessment ◽  
Phyllodes Tumour ◽  
Phyllodes Tumours

Phyllodes tumours are rare entities of fibroepithelial diseases. The exact pathogenesis and their relationship with fibroadenomas are oblivious. Women aged between 35 to 55 years are commonly affected, even younger in Asian population. Triple assessment should be applied as a guide to management in any breast pathology. Clinical appearances are typically diagnostic for phyllodes tumours. Even though sometimes inconclusive, mammography and ultrasonography are the main imaging modalities. Although the role of cytology is debatable, presence of both epithelial and stromal elements supports the diagnosis especially in malignant type. Core biopsy is rather favored in view of higher accuracy for the diagnosis. Accurate preoperative assessment and histologic diagnosis allow correct surgical intervention and subsequent avoidance of reoperation. Surgical management can be either wide excision with more than 1 cm margins or mastectomy without axillary surgery. Local recurrence has been associated with inadequate excision of the pseudopod. Adjuvant radiotherapy is recommended for positive surgical margin and for local control of borderline and malignant phyllodes tumors. The role of chemotherapy and endocrine therapy has not been fully studied.

scholarly journals The Role of Lymph Node Dissection in Intrahepatic Cholangiocarcinoma: A Multicenter Retrospective Study. 

2021 ◽  
Author(s):  
Hanjie Hu ◽  
Gang Xu ◽  
Shunda Du ◽  
Zhiwen Luo ◽  
Hong Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Surgical Margin ◽  
Disease Free Survival ◽  
Positive Surgical Margin ◽  
Node Dissection ◽  
Independent Risk Factors

Abstract BackgroundLymph node dissection (LND) is of great significance in intrahepatic cholangiocarcinoma (ICC). Although the National Comprehensive Cancer Network (NCCN) guidelines recommend routine LND in ICC, the effects of LND remains controversial. This study aimed to explore the role and application of LND in ICC.MethodsPatients were identified in two Chinese academic centers. Inverse probability of treatment weighting (IPTW) was used to reduce bias. Kaplan–Meier curves and Cox proportional hazards models were used to compare overall survival (OS) and disease-free survival (DFS).ResultsOf 232 patients, 177 (76.3%) underwent LND, and 71 (40.1%) had metastatic lymph nodes. A minimum of 6 lymph nodes were dissected in 66 patients (37.3%). LND did not improve the prognosis of ICC. LNM >3 may have worse OS and DFS than LNM 1-3, especially in the LND >=6 group. For nLND patients, the adjuvant treatment group had better OS and DFS.ConclusionsCA 19-9, CEA, operative time, positive surgical margin, and T stage were independent risk factors for OS; CEA and differentiation were independent risk factors for DFS. LND has no definite predictive effect on prognosis. Patients with 4 or more LNMs may have a worse prognosis than patients with 1-3 LNMs. Adjuvant therapy may benefit patients of nLND.

scholarly journals Determinants of surgical morbidity in gastric cancer: experience of a single center and literature review

2020 ◽  
Vol 2 (4) ◽  
pp. Press
Author(s):  
Houyem Mansouri ◽  
Ines Zemni ◽  
Mohamed Ali Ayadi ◽  
Ines Ben Safta ◽  
Tarek Ben Dhiab ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Operative Time ◽  
Multiple Logistic Regression Analysis ◽  
Significant Risk ◽  
Surgical Margin ◽  
Length Of Hospital Stay ◽  
Extent Of Resection ◽  
Surgical Morbidity ◽  
Cancer Experience

Background This study aimed to evaluate the severity of intraoperative and post operative complications of gastric cancer surgery and to investigate the predictive factors correlated to surgical morbidity. Methods We included 145 patients operated for gastric cancer. We investigated the risk factors associated with complications, length of hospital stay, operative time, and intraoperative blood transfusion (BT). Significant risk factors were analyzed by multiple logistic regression analysis. Results Postoperative complications occurred in 32 patients (22.1 %) and the rate of major complications was 7.6%. The rate of anastomotic fistula was 6.9% and was correlated to diabetes, tumor size, operative time, surgical margin, and extended lymphadenectomy. The mean risk factors for postoperative morbidity were the presence of comorbidities and ASA score (p = 0.021), intraoperative BT (p = 0.045) and prolonged operative time (p = 0.055). Conclusion surgical morbidity of gastric cancer is correlated to the extent of resection as well as the clinical and histological characteristics.

scholarly journals Does adjuvant radiation therapy benefit women with small mammography-detected breast cancers?

2017 ◽  
Vol 24 (1) ◽  
pp. 28
Author(s):  
K. Jerzak ◽  
N. Dudalski ◽  
K. Pritchard ◽  
P. Sun ◽  
S.A. Narod
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Cox Regression ◽  
Tumour Size ◽  
Demographic Data ◽  
Breast Conserving Surgery ◽  
Adjuvant Radiation ◽  
Breast Cancers ◽  
Adjuvant Radiation Therapy ◽  
Actuarial Risk

Background Women with small nonpalpable breast tumours have an excellent prognosis. The benefit of radiotherapy in this group of low-risk women is unknown.Methods A cohort of 1595 women with stages i–iii invasive breast cancer treated with breast-conserving surgery were followed for local recurrence. Using t-tests, baseline demographic data and tumour characteristics were compared forthe women who had palpable (n = 1023) and mammography-detected (n = 572) breast cancers. The 15-year actuarial risk of local recurrence was estimated using a Kaplan–Meier method, stratified for adjuvant radiation therapy (yes or no), tumour palpability (palpable or not), and tumour size (≤1 cm or >1 cm). Hazard ratios (hrs) and 95% confidence intervals (95% cis) were calculated using a multivariate Cox regression model. Results were considered statistically significant if 2-tailed p values were less than 0.05.Results Among women with a nonpalpable tumour, the 15-year actuarial rates of local recurrence were, respectively, 13.9% and 18.3% for those treated and not treated with adjuvant radiation therapy (hr: 0.65; 95%ci: 0.40 to 1.06; p = 0.08). Among women with small nonpalpable breast cancers (≤1.0 cm), the rates were 14.6% and 13.4% respectively (p = 0.67). The absolute reduction in 15-year local recurrence was 11.0% for women with palpable tumours.Conclusions Our results suggest that women with small (<1 cm) screen-detected nonpalpable breast cancers likely derive little benefit from adjuvant radiotherapy; however, an adequately powered randomized trial would be required to make definitive conclusions.

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