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中华乳腺病杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 115 -119. doi: 10.3877/cma.j.issn.1674-0807.2026.02.007

综述

乳腺叶状肿瘤的诊疗进展与全程管理策略
冯学乾, 王千丹, 张旭()   
  1. 730000 兰州,甘肃省妇幼保健院乳腺科
  • 收稿日期:2025-11-29 出版日期:2026-04-01
  • 通信作者: 张旭

Diagnosis, treatment and comprehensive management strategies for breast phyllodes tumors

Xueqian Feng, Qiandan Wang, Xu Zhang()   

  • Received:2025-11-29 Published:2026-04-01
  • Corresponding author: Xu Zhang
引用本文:

冯学乾, 王千丹, 张旭. 乳腺叶状肿瘤的诊疗进展与全程管理策略[J/OL]. 中华乳腺病杂志(电子版), 2026, 20(02): 115-119.

Xueqian Feng, Qiandan Wang, Xu Zhang. Diagnosis, treatment and comprehensive management strategies for breast phyllodes tumors[J/OL]. Chinese Journal of Breast Disease(Electronic Edition), 2026, 20(02): 115-119.

乳腺叶状肿瘤(PTB)是一种具有复发与转移潜能的罕见纤维上皮性肿瘤,临床管理面临挑战。目前,PTB的诊疗规范存在争议,相关诊断标准、手术切缘决策、辅助治疗价值及基于风险分层的全程管理策略尚缺乏高级别循证指南,尤其在手术切缘宽度、放射治疗指征及全身治疗等方面尚未形成共识。本文主要阐述PTB诊疗的最新进展,系统梳理全程管理要点,并展望以分子特征为导向的精准诊疗模式,以期为临床实践提供循证参考。

表1 叶状肿瘤组织病理学分级标准
表2 乳腺叶状肿瘤患者随访监测建议
[1]
Wang HWang XWang CF. Comparison of clinical characteristics between benign borderline and malignant phyllodes tumors of the breast[J]. Asian Pac J Cancer Prev201415(24): 10791-10795.
[2]
Chen JJZhu IPatel A, et al. Management of concurrent malignant phyllodes tumor and invasive breast carcinoma[J]. Adv Radiat Oncol20249(5): 101448.
[3]
Tan PH. Fibroepithelial lesions revisited: implications for diagnosis and management[J]. Mod Pathol202134(Suppl 1): 15-37.
[4]
Zhou ZRWang CCYang ZZ, et al. Phyllodes tumors of the breast:diagnosis, treatment and prognostic factors related to recurrence[J]. J Thorac Dis20168(11): 3361-3368.
[5]
Hasdemir STolunay ŞÖzşen M, et al. Phyllodes tumor of the breast: a clinicopathological evaluation of 55 cases[J]. Eur J Breast Health202016(1): 32-38.
[6]
Lu YChen YZhu L, et al. Local recurrence of benign, borderline, and malignant phyllodes tumors of the breast: a systematic review and meta-analysis[J]. Ann Surg Oncol201926(5): 1263-1275.
[7]
Bozkurt HKarakaya IBAktas E, et al. Coexistence of phylloides tumour and invasive ductal cancer in the breast[J]. Niger J Clin Pract201922(8): 1169-1171.
[8]
Neron MSajous CThezenas S, et al. Surgical margins and adjuvant therapies in malignant phyllodes tumors of the breast: a multicenter retrospective study[J]. Ann Surg Oncol202027(6): 1818-1827.
[9]
Cervoni GEQuintana LErlinger AL, et al. Local recurrence after breast-conserving therapy for phyllodes tumors: a 15-year retrospective review[J]. Breast J202026(5): 988-990.
[10]
Mituś JWBlecharz PWalasek T, et al. Treatment of patients with distant metastases from phyllodes tumor of the breast[J]. World J Surg201640(2): 323-328.
[11]
Barth RJ JrWells WAMitchell SE, et al. A prospective, multi-institutional study of adjuvant radiotherapy after resection of malignant phyllodes tumors[J]. Ann Surg Oncol200916(8): 2288-2294.
[12]
Limaiem FKashyap S. Phyllodes tumor of the breast[M/OL]. Treasure Island (FL): StatPearls Publishing, (2023-01-01)[2025-10-12].
[13]
Hamid SARahmat KRamli MT, et al. Radiopathological characteristics and outcomes of phyllodes tumor of the breast in Malaysian women[J]. Medicine201897(31): e11412.
[14]
Arora MGupta PSyed A, et al. Mammographic and ultrasonographic concordance in pathologically proven phyllodes tumors: a retrospective study[J]. Breast J202026(5): 1087-1089.
[15]
Zervoudis SXepapadakis GPsarros N, et al. Management of malignant and borderline phyllodes tumors of the breast: our experience[J]. J BUON201924(4): 1521-1525.
[16]
Li LJZeng HOu B, et al. Ultrasonic elastography features of phyllodes tumors of the breast: a clinical research[J]. PLoS One20149(1): e85257.
[17]
Papas YEl Asmar AGhandour F, et al. Malignant phyllodes tumors of the breast: a comprehensive literature review[J] . Breast J202026(2): 240-244.
[18]
Rayzah M. Phyllodes Tumors of the breast: a literature review[J]. Cureus202012(9): e10288.
[19]
Ma WGuo XLiu L, et al. Magnetic resonance imaging semantic and quantitative features analyses: an additional diagnostic tool for breast phyllodes tumors[J]. Am J Transl Res202012(5): 2083-2092.
[20]
谭璇妮,陈显春,张婷,等. 空芯针穿刺活组织检查对乳腺占位性病变诊断的临床价值[J/OL]. 中华乳腺病杂志(电子版)201812(3): 160-164.
[21]
牛昀. 中国临床案例·乳腺肿瘤病理诊断案例精选[M]. 北京:世界图书出版有限公司,2025.
[22]
王云帆,宗雪,薛卫成. 乳腺叶状肿瘤诊断分级的困惑和进展[J]. 中华病理学杂志202554(3): 219-223.
[23]
陈畅,孙强,李炎. 中国女性乳腺分叶状肿瘤诊治专家共识[J]. 中国研究型医院202310(4): 1-14.
[24]
Li JTsang JYChen C, et al. Predicting outcome in mammary phyllodes tumors: relevance of clinicopathological features[J]. Ann Surg Oncol201926(9): 2747-2758.
[25]
Kim SHKim LKang SM. Lacrimal sac metastasis from phyllodes tumor of the breast[J]. Korean J Ophthalmol202034(1): 85-87.
[26]
Tan PHEllis IAllison K, et al. The 2019 World Health Organization classification of tumours of the breast[J] . Histopathology202077(2): 181-185.
[27]
Wu HLi LYang J, et al. Radiotherapy with apatinib for recurrence of malignant phyllodes tumor of the breast: a case report[J]. Medicine202099(3): e18808.
[28]
Kim JHLee JY. Malignant phyllodes tumor of the breast with liposarcomatous differentiation: a case report with imaging findings[J]. Radiol Case Rep201914(5): 531-534.
[29]
Cates JMM. The AJCC 8th edition staging system for soft tissue sarcoma of the extremities or trunk: a cohort study of the SEER database[J]. J Natl Compr Canc Netw201816(2): 144-152.
[30]
Giacomazzi JKoehler-Santos PPalmero EI, et al. A TP53 founder mutation, p. R337H, is associated with phyllodes breast tumors in Brazil[J]. Virchows Arch2013463(1): 17-22.
[31]
Rosenberger LHThomas SMHieken TJ, et al. Germline genetic mutations in a multi-center cohort of 248 phyllodes tumors[J]. Breast Cancer Res Treat2025209(2): 275-282.
[32]
Lissidini GMulè ASantoro A, et al. Malignant phyllodes tumor of the breast: a systematic review[J]. Pathologica2022114(2): 111-120.
[33]
Lien HCHuang CSYang YW, et al. Mutational analysis of MED12 exon 2 in a spectrum of fibroepithelial tumours of the breast: implications for pathogenesis and histogenesis[J]. Histopathology201668(3): 433-441.
[34]
Geyer FCBurke KAPiscuoglio S, et al. Genetic analysis of uterine adenosarcomas and phyllodes tumors of the breast[J]. Mol Oncol201711(8): 913-926.
[35]
Nozad SSheehan CEGay LM, et al. Comprehensive genomic profiling of malignant phyllodes tumors of the breast[J]. Breast Cancer Res Treat2017162(3): 597-602.
[36]
Reinisch MKuemmel SBreit E, et al. Two progressed malignant phyllodes tumors of the breast harbor alterations in genes frequently involved in other advanced cancers[J]. Orphanet J Rare Dis202116(1): 363.
[37]
Hench JVlajnic TSoysal SD, et al. An integrated epigenomic and genomic view on phyllodes and phyllodes-like breast tumors[J] . Cancers(Basel)202214(3): 667.
[38]
Mohd Ali NANasaruddin AFMohamed SS, et al. Ki67 and P53 expression in relation to clinicopathological features in phyllodes tumour of the breast[J]. Asian Pac J Cancer Prev202021(9): 2653-2659.
[39]
Turashvili GDing QLiu Y, et al. Comprehensive clinical-pathologic assessment of malignant phyllodes tumors: proposing refined diagnostic criteria[J]. Am J Surg Pathol202347(11): 1195-1206.
[40]
Li XNguyen TTAZhang J, et al. Validation study of the newly proposed refined diagnostic criteria for malignant phyllodes tumor with 136 borderline and malignant phyllodes tumor cases[J]. Am J Surg Pathol202448(9): 1146-1153.
[41]
叶艳娜,叶瑞婷,陈艳玲,等. 基于影像学表现和临床病理特征预测良性与交界性乳腺叶状肿瘤复发的列线图模型[J/OL]. 中华乳腺病杂志(电子版)202317(4): 229-237.
[42]
Ditsatham CChongruksut W. Phyllodes tumor of the breast: diagnosis,management and outcome during a 10-year experience[J]. Cancer Manag Res201911: 7805-7811.
[43]
Assi HSalem RSukhon F, et al. Phyllodes tumors of the breast treated in a tertiary health care center: case series and literature review[J]. J Int Med Res202048(1):03000605880353.
[44]
Gradishar WJMoran MSAbraham J, et al. Breast cancer, version 3. 2022, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw202220(6): 691-722.
[45]
Haberer SLaé MSeegers V, et al. Management of malignant phyllodes tumors of the breast: the experience of the Institut Curie[J]. Cancer Radiother200913(4): 305-312.
[46]
Shafi AAAlHarthi BRiaz MM, et al. Giant phyllodes tumour with axillary & interpectoral lymph node metastasis: a rare presentation[J]. Int J Surg Case Rep202066: 350-355.
[47]
Gregston APMetter DMOsborne CRC, et al. Giant malignant phyllodes tumor with metastasis to the brain[J]. Proc (Bayl Univ Med Cent)201932(1): 116-118.
[48]
张迈,宋达疆,张永林,等. 自体组织乳房重建用于修复乳腺叶状肿瘤术后胸壁缺损[J/OL]. 中华乳腺病杂志(电子版)202317(3): 163-166.
[49]
Yeh RChong LNHughes TM. Malignant phyllodes: excellent response to neoadjuvant radiotherapy[J]. ANZ J Surg201989(12): 1668-1670.
[50]
Choi NKim KShin KH, et al. The characteristics of local recurrence after breast-conserving surgery alone for malignant and borderline phyllodes tumors of the breast (KROG 16-08)[J]. Clin Breast Cancer201919(5): 345-353. e2.
[51]
Sun LZhu RGinter P, et al. Coexisting DCIS and phyllodes breast tumors in young Chinese women: case series[J]. Int J Surg Case Rep201956: 13-16.
[52]
Tsang JYTse GM. ASO author reflections: resolving the challenges in the management of mammary phyllodes tumor[J]. Ann Surg Oncol201926(Suppl 3): 774-775.
[53]
Rosenberger LHThomas SMNimbkar SN, et al. Contemporary multi-institutional cohort of 550 cases of phyllodes tumors (2007-2017) demonstrates a need for more individualized margin guidelines[J]. J Clin Oncol202139(3): 178-189.
[54]
Toussaint APiaget-Rossel RStormacq C, et al. Width of margins in phyllodes tumors of the breast: the controversy drags on? —a systematic review and meta-analysis[J]. Breast Cancer Res Treat2021185(1): 21-37.
[55]
Thind APatel BThind K, et al. Surgical margins for borderline and malignant phyllodes tumours[J] . Ann R Coll Surg Engl2020102(3): 165-173.
[56]
Sun DTang LXing H, et al. Recurrent borderline phyllodes tumor in nipple: a rare case report and review of the literature[J]. Gland Surg20209(2): 452-458.
[57]
Lim RSCordeiro ELau J, et al. Phyllodes tumors: the predictors and detection of recurrence[J]. Can Assoc Radiol J202172(2): 251-257.
[58]
Tukenmez MMollavelioglu BOnder S, et al. Surgery for phyllodes tumour of the breast. What should be surgical margins?[J]. ANZ J Surg202393(1/2): 257-262.
[59]
Saxena PLalchandani ADausage C. Recurrent phyllodes tumour of breast infiltrating the latissimus dorsi reconstruction flap[J]. BMJ Case Rep202013(12):e238306.
[60]
Gupta KPuri GKataria K, et al. Complex chest wall reconstruction after excision of malignant phyllodes tumour[J]. BMJ Case Rep202215(9): e247067.
[61]
Chao XChen KZeng J, et al. Adjuvant radiotherapy and chemotherapy for patients with breast phyllodes tumors: a systematic review and meta-analysis[J]. BMC Cancer201919(1):372.
[62]
Roberts ACLunt LGCoogan AC, et al. The role of radiation therapy in locally advanced breast cancer in a patient with Li-fraumeni syndrome[J]. Am Surg202389(11): 4958-4960.
[63]
Wakankar RDharmashaktu YVenugopal A, et al. Malignant phyllodes tumor with sphenoid bone metastasis detected on 99mTc-MDP SPECT/CT and 18F-FDG PET/CT[J]. Clin Nucl Med202550(4): e223-e224.
[64]
Ostapenko EBurneckis AOstapenko A, et al. Malignant phyllodes tumor of the breast with metastases to the lungs: a case report and literature review[J]. Radiol Case Rep202217(10): 4006-4012.
[65]
Zieba DPories SThota HB, et al. Malignant phyllodes tumor of the breast with multiple cutaneous metastasis resembling pleomorphic rhabdomyosarcoma[J]. Am J Dermatopathol202547(3): 217-219.
[66]
Charoenyothakun AShotelersuk KNantavithya C, et al. The impact of adjuvant radiotherapy on borderline and malignant phyllodes tumors of the breast[J]. Breast Cancer202532(5): 1006-1012.
[67]
Gronchi AMiah ABDei Tos AP, et al. Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS clinical practice guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol202132(11): 1348-1365.
[68]
Álvarez BMontero ACiérvide R, et al. Real-world efficacy of postoperative radiotherapy with a moderate dose-escalation for phyllodes tumors of the breast[J]. Transl Breast Cancer Res20234: 19.
[69]
Yogi VSingh OP. Effect of postoperative time for adjuvant radiotherapy in malignant phyllodes tumor: an institutional experience[J]. J Cancer Res Ther201915(5): 1194-1195.
[70]
Kyriazoglou AZagouri FDimopoulos MA. Olaratumab administered in two cases of phyllodes tumour of the breast: end of the beginning?[J]. ESMO Open20194(3):e000479.
[71]
中国抗癌协会肉瘤专业委员会,中国临床肿瘤学会. 软组织肉瘤诊治中国专家共识(2015年版)[J]. 中华肿瘤杂志201638(4): 310-320.
[72]
Wisdom AJMowery YMRiedel RF, et al. Rationale and emerging strategies for immune checkpoint blockade in soft tissue sarcoma[J]. Cancer2018124(19): 3819-3829.
[73]
Kelly CMAntonescu CRBowler T, et al. Objective response rate among patients with locally advanced or metastatic sarcoma treated with talimogene laherparepvec in combination with pembrolizumab: a phase 2 clinical trial[J]. JAMA Oncol20206(3): 402-408.
[74]
Katsuya HSano HSano H, et al. Case report: efficacy of immune checkpoint inhibitors for high tumour mutational burden malignant phyllodes tumours of the breast as revealed by comprehensive genomic profiling[J]. Front Immunol202516: 1549452.
[75]
Neron MSajous CThezenas S, et al. Impact of metastasis surgery and alkylating-agent-based chemotherapy on outcomes of metastatic malignant phyllodes tumors: a multicenter retrospective study[J]. Ann Surg Oncol202027(5): 1693-1699.
[76]
Carmine VDario TMaria PF, et al. The pathologic and genomic evolution of primary malignant phyllodes tumors of the breast: retrospective cohort study and case-control genomic analysis[J]. Oncologist202530(2): oyaf012.
[77]
Bishr MKBanks JAbdelaziz MS, et al. Multidisciplinary management of phyllodes tumours and breast sarcoma: a cross-sectional survey of clinical practice across the UK and Ireland[J]. Clin Oncol (R Coll Radiol)202436(1): e31-e39.
[78]
Ofri AStuart KEChan B, et al. Diagnosis and management of phyllodes tumours for the surgeon: an algorithm[J]. Surgeon202220(6): e355-e365.
[79]
Bishr MK, Humphreys A, Ahmed M, et al. Contemporary management of phyllodes tumours of the breast: proposal for recommendations from the UK Association of Breast Surgery[J]. Br J Surg2024112(1):znae277.
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