دورية أكاديمية
Validation Study of the Newly Proposed Refined Diagnostic Criteria for Malignant Phyllodes Tumor With 136 Borderline and Malignant Phyllodes Tumor Cases.
| العنوان: | Validation Study of the Newly Proposed Refined Diagnostic Criteria for Malignant Phyllodes Tumor With 136 Borderline and Malignant Phyllodes Tumor Cases. |
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| المؤلفون: | Li X; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA., Nguyen TTA; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA., Zhang J; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA., Nayak A; Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA., Liu Y; Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA., Duckworth LA; Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH., Zhang G; Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH., Bakkar R; Department of Pathology, City of Hope Cancer Center, Duarte, CA., Agarwal I; Department of Pathology, Northwestern University, Evanston, IL., Hou Y; Department of Pathology, Wake Forest University, Winston-Salem, NC., Guo H; Department of Pathology, University of Alabama at Birmingham, Birmingham, AL., Huang X; Department of Pathology, University of Alabama at Birmingham, Birmingham, AL., Wei S; Department of Pathology, University of Alabama at Birmingham, Birmingham, AL., Yasmeen S; Department of Pathology, Roswell Park Cancer Center, Buffalo, NY., Thaer K; Department of Pathology, Roswell Park Cancer Center, Buffalo, NY., Huang H; Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou., Zhang H; Department of Pathology, The Fourth Hospital of Hebei Medical University, Hebei., Smith GH; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA., Turashvili G; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA., Peng L; Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA., Liu Y; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai., Yang W; Department of Pathology, University of Rochester, Rochester, NY., Siziopikou KP; Department of Pathology, Northwestern University, Evanston, IL. |
| المصدر: | The American journal of surgical pathology [Am J Surg Pathol] 2024 Jun 27. Date of Electronic Publication: 2024 Jun 27. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wolters Kluwer Health, Inc Country of Publication: United States NLM ID: 7707904 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-0979 (Electronic) Linking ISSN: 01475185 NLM ISO Abbreviation: Am J Surg Pathol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: <2015- > : Philadelphia, PA : Wolters Kluwer Health, Inc. Original Publication: New York, Masson. |
| مستخلص: | The World Health Organization (WHO) diagnostic criteria for malignant phyllodes tumor (MPT) may miss a significant number of MPTs with metastatic potential. New refined diagnostic criteria (Refined Criteria) for MPT were recently proposed. The aim of this study is to validate the Refined Criteria. This validation study included 136 borderline (borderline phyllodes tumor [BoPT]) and MPT cases that were not included in the initial study. We evaluated tumor classifications based on both the Refined Criteria and the WHO criteria. The Refined Criteria defines MPT when these criteria are met (1) stromal overgrowth with ≥ 1 feature(s) of marked stromal cellularity, marked stromal cytologic atypia, or ≥10 mitoses per 10 high-power fields (10 mitoses/10 HPFs) or (2) marked stromal cellularity with ≥1 feature(s) of marked stromal cytologic atypia, ≥10 mitoses/10 HPFs or permeative border. The WHO criteria require all 5 morphologic features (stromal overgrowth, permeative border, marked stromal cellularity, marked stromal cytologic atypia, and ≥10 mitoses/10 HPFs) for an MPT diagnosis. Using the Refined Criteria, none of the 61 BoPTs developed metastasis and 40.0% of the 75 MPTs developed metastases; local recurrence was seen in 11.5% BoPTs and 25.3% MPTs. Using the WHO criteria, 9.6% of the 94 BoPTs developed metastases and 50.0% of the 42 MPTs developed metastases; 14.9% of the BoPTs had local recurrence and 28.6% of the MPTs had local recurrence. Nine (30.0%) of the 30 tumors that developed distant metastases were diagnosed as BoPTs by the WHO criteria. When we combined the 75 MPTs from this validation cohort with the 65 MPT cases from the published data using the Refined Criteria, 50 (35.7%) of the 140 MPTs developed metastases, whereas 8 cases with metastases were <5 cm. In the univariate analysis with log-rank test, stromal overgrowth, marked stromal cellularity, marked stromal cytologic atypia, ≥10 mitoses/10 HPFs, presence of heterologous components other than liposarcomatous component, and presence of stromal necrosis were significantly associated with the risk of metastasis (all with P < 0.05). In multivariate analysis with Cox proportional hazard regression, stromal overgrowth and marked stromal cellularity were significantly associated with metastasis (both with P < 0.001). The Refined Criteria are superior to the WHO criteria in predicting the clinical outcomes of BoPTs and MPTs. Using the Refined Criteria, 35.7% of 140 patients with MPT developed metastases, whereas none (0%) of the patients with BoPT developed metastases. Patients with MPT have a high metastatic rate; these patients may benefit from systemic chemotherapy or targeted therapies. In contrast, patients with BoPT may be managed with complete local excision alone without chemotherapy. Competing Interests: Conflicts of Interest and Source of Funding: X.L. has served as an advisor for Astra Zeneca, Roche, Eli Lilly, and Onviv, and Champions Oncology has funded research in Xiaoxian Li’ lab. S.W. has served as Breast Pathology Faculty Advisory Board for Daiichi Sankyo Inc. and AstraZeneca. For the remaining authors, none were declared. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.) |
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| تواريخ الأحداث: | Date Created: 20240627 Latest Revision: 20240627 |
| رمز التحديث: | 20240627 |
| DOI: | 10.1097/PAS.0000000000002264 |
| PMID: | 38934254 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1532-0979 |
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| DOI: | 10.1097/PAS.0000000000002264 |