PURPOSE Phyllodes tumors (PT) of the breast are rare fibroepithelial neoplasms. Information is controversial in the literature regarding to the optimal surgical management. Most studies suggested margins of at least 10 mm while some recent studies suggested narrower margins without an increased risk of local recurrences (LR) and distant metastases (DM). The objective of this systematic review was to identify and compare studies that assessed these different practices. METHODS A systematic review was performed through five databases up to April 2019. Studies exploring the association between the width of margins, subtypes of PT, and the LR and DM rates were considered for inclusion. A statistical model for analyzing sparse data and rare events was used. RESULTS Thirteen studies met eligibility criteria and were selected. Considering a threshold of 10 mm (margins < 10 vs margins ≥ 10 mm), the 5-year incidence rate of LR was estimated to be 5.22 vs. 3.63 (diff. -1.59) per 100 person-years for benign PT, 9.60 vs. 7.33 (diff. -2.27) for borderline PT, and 28.58 vs. 21.84 (diff. -6.74) for malignant PT. For DM, it was estimated to be 0.88 vs. 0.86 (diff. -0.02) for benign PT, 1.61 vs. 1.74 (diff. 0.13) for borderline PT, and 4.80 vs 5.18 (diff. 0.38) for malignant PT. The data for a threshold of 1 mm were not sufficient to draw any conclusions. CONCLUSION Irrespective of tumor grade, we found that DM was a rarer event than LR. Malignant PT had the highest incidence rate of LR and DM. This meta-analysis found a clear association between width of margins and LR rates. Whatever the tumor grade, surgical margins ≥ 10 mm guaranteed a lower risk of LR than margins < 10 mm. On the other hand, the width of margin did not influence the apparition of DM.

中文翻译：

---

乳房叶状肿瘤的边缘宽度：争议还在继续？-系统评价和荟萃分析。

目的 乳腺叶状肿瘤 (PT) 是罕见的纤维上皮肿瘤。文献中关于最佳手术治疗的信息存在争议。大多数研究建议切缘至少为 10 毫米，而最近的一些研究建议切缘更窄，而不会增加局部复发 (LR) 和远处转移 (DM) 的风险。本系统评价的目的是确定和比较评估这些不同做法的研究。方法 对截至 2019 年 4 月的五个数据库进行了系统评价。考虑纳入探讨切缘宽度、PT 亚型以及 LR 和 DM 率之间关联的研究。使用了用于分析稀疏数据和罕见事件的统计模型。结果 13 项研究符合资格标准并被选中。考虑到 10 毫米的阈值（边缘 < 10 与边缘 ≥ 10 毫米），对于良性 PT，LR 的 5 年发病率估计为每 100 人年 5.22 与 3.63（差异 -1.59），9.60 与 9.60 . 7.33（差异 -2.27）对于临界 PT，以及 28.58 与 21.84（差异 -6.74）对于恶性 PT。对于 DM，估计良性 PT 为 0.88 与 0.86（差异 -0.02），临界 PT 为 1.61 与 1.74（差异 0.13），恶性 PT 为 4.80 与 5.18（差异 0.38）。1 毫米阈值的数据不足以得出任何结论。结论 无论肿瘤分级如何，我们发现 DM 是比 LR 更罕见的事件。恶性 PT 的 LR 和 DM 发生率最高。该荟萃分析发现边缘宽度与 LR 率之间存在明显关联。无论肿瘤分级如何，手术切缘≥ 10 毫米保证 LR 风险低于切缘 < 10 毫米。另一方面，边缘的宽度不影响 DM 的出现。