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Postoperative radiation therapy in localized breast malignant phyllodes tumors: RPA-derived risk model identifies
Wei-Hong Zheng1, Zhi-Qing Long2, Jia Kou3
1Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, People's Republic of China.
Introduction:
Breast malignant phyllodes tumors (MPTs) are rare, aggressive neoplasms with high locoregional recurrence rates despite wide-margin resection. Though NCCN recommends postoperative radiation therapy (PORT), its efficacy remains controversial. This study aims to evaluate PORT's survival benefits in non-metastatic MPT and refine individualized radiation therapy strategies in clinical practice.
Methods:
We retrospectively analyzed 108 non-metastatic MPT patients treated with R0 resection. Comparative analyses employed Kaplan-Meier methods, multivariable Cox models, and recursive partitioning analysis (RPA) to identify high-benefit PORT subgroups for local recurrence-free survival (LRFS).
Results:
PORT was identified as an independent prognostic factor for LRFS (P < 0.01), while showing no protective effect on distant metastasis-free survival or overall survival. The final RPA model established three prognostic groups: low-risk (tumor size ≤5.0 cm with N0, and underwent mastectomy), intermediate-risk (tumor size >5.0 cm with N0, and underwent mastectomy), and high-risk (underwent mastectomy but with N+, or underwent BCS with any tumor size). Significant LRFS benefits were observed in intermediate-risk (P = 0.01) and high-risk groups (P < 0.05) compared to non-PORT counterparts, whereas low-risk patients showed no significant improvement (P = 0.29).
Conclusions:
PORT significantly improved LRFS for MPT patients, particularly benefiting intermediate- and high-risk subgroups. This proposed risk stratification provided evidence to guide individualized PORT decision making.
