Impact of Surgical Approach on Survival and Recurrence in Borderline and Malignant Phyllodes Tumours: A Systematic Review and Meta-Analysis.

BACKGROUND

Phyllodes tumours of the breast exhibit a spectrum of biologic behaviour, with a predisposition to recur locally and metastasize distantly in their malignant form. There are limited data regarding the optimal surgical approach.

OBJECTIVES

Our systematic review and meta-analysis aimed to determine the impact of breast conserving surgery (BCS) compared to mastectomy on overall survival (OS), disease-free survival (DFS), and local recurrence (LR) for patients with borderline and malignant phyllodes tumours to guide treatment planning.

DATA SOURCES: We identified relevant studies from PubMed, MEDLINE, Embase, and Google Scholar using the updated PRISMA Guidelines.

REVIEW

METHODS

Included studies compared breast conservation and mastectomy and reported rates of OS, DFS, and LR for individuals with borderline or malignant phyllodes tumours. A random-effects model was used to pool relative risk data. Heterogeneity was assessed using Cochran's Q statistic.

RESULTS

Out of 1950 screened by our search, 13 studies were deemed suitable for inclusion. These studies included 874 patients undergoing breast conservation and 784 undergoing mastectomy. The median follow-up time was 65 months. There was improved OS following BCS in the malignant (pooled RR 0.9, 95% CI 0.85-0.95) and combined borderline and malignant cohorts (pooled RR 0.91, 95% CI 0.86-0.95). There was no difference in DFS in the malignant or combined cohorts. LR risk was increased following BCS in both malignant (pooled RR 2.47, 95% CI 1.64-3.72) and combined cohorts (pooled RR 2.25, 95% CI 1.66-3.04). There was no significant heterogeneity.

CONCLUSIONS

For individuals with borderline or malignant phyllodes tumours, BCS should be offered, where feasible, as part of an individualised multidisciplinary approach.