Does surgical margin status truly affect local recurrence in benign and borderline phyllodes tumors of the breast?
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BACKGROUND: Phyllodes tumors of the breast are rare and classified into three groups-benign, borderline, and malignant-based on their malignant potential. Surgical resection is the primary treatment modality; however, the necessity of clear surgical margins remains a topic of debate in the literature. This study aimed to evaluate the relationship between surgical margin status and local recurrence in benign and borderline phyllodes tumors. METHODS: A total of 177 patients diagnosed with phyllodes tumors from two centers were included. Patients were analyzed based on demographic, clinical, pathological, and survival data. RESULTS: The median age was 38 years (range: 15-78), and all patients were female. The most commonly performed breast surgery was wide local excision in 173 patients (97.7 %). Final pathological examination revealed that 136 patients (76.8 %) had benign phyllodes tumors, while 41 patients (23.2 %) had borderline phyllodes tumors. The median pathological tumor diameter was 35 mm (IQR: 27-55 mm). During a median follow-up of 60 months, local recurrence occurred in 12 patients (6.8 %), while no systemic metastasis or tumor-related death was observed. Patients with borderline phyllodes tumors had a higher local recurrence rate and shorter recurrence-free survival (RFS) (p = 0.022 and p = 0.013, respectively). Cox regression analysis identified tumor type as the only independent factor affecting RFS, with borderline phyllodes tumors demonstrating a shorter RFS compared to benign phyllodes tumors (p = 0.015). CONCLUSION: Surgical margin status was not associated with local recurrence in benign and borderline phyllodes tumors. Therefore, re-excision decisions based on margin proximity or positivity should be individualized.