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Utility of the Singapore nomogram for predicting recurrence-free survival in Japanese women with breast phyllodes tumours
  1. Rieko Nishimura1,
  2. Puay Hoon Tan2,
  3. Aye Aye Thike2,
  4. Min-Han Tan3,
  5. Naruto Taira4,
  6. Hui Hua Li5,
  7. Shozo Ohsumi6
  1. 1 Department of Clinical Laboratory, Shikoku Cancer Center, Matsuyama, Japan
  2. 2 Department of Pathology, Singapore General Hospital, Singapore
  3. 3 Institute of Bioengineering and Nanotechnology, Singapore
  4. 4 Department of Breast and Endocrine Surgery, Okayama University Hospital, Okayama, Japan
  5. 5 Department of Clinical Research, Singapore General Hospital, Singapore
  6. 6 Department of Breast Oncology, Shikoku Cancer Center, Matsuyama, Japan
  1. Correspondence to Dr Rieko Nishimura, Department of Clinical Laboratory, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama, Ehime 791-0280, Japan; rnishimu{at}

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Some tumour grading systems have attempted to predict the risk of local recurrence and metastatic potential in patients with phyllodes tumours (PTs). However, there has been no grading scheme that can reliably predict the behaviour of an individual patient diagnosed with PT to date. A nomogram for prediction of recurrence-free survival (RFS) in each individual with PT was introduced by Tan et al. 1 We examined whether the nomogram (referred here as the Singapore nomogram) could be useful for Japanese patients. This is the first report validating the use of the Singapore nomogram in a different population. The nomogram is based on the degree of stromal atypia (mild, moderate, marked), stromal mitoses per 10 HPF (assessed in the most mitotically active areas), stromal overgrowth (absent or present) and surgical margins (negative or positive). The likelihood of 1-year, 3-year, 5-year or 10-year RFS of PT was determined by the above four variables. Calculation of RFS is automated through a computerised program at the website (

We used the same cases documented in our previous study2 to investigate the factors involved in local recurrence and the indications for re-excision in margin positive cases. Forty-three PT patients treated between January 1980 and …

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  • Contributors RN planned the study and wrote the manuscript. PHT, AAT and M-HT contributed to the content. HHL performed the statistical analysis. NT and SO contributed the cases.

  • Funding This study was supported in part by Grants-in-Aid for Clinical Research from the National Hospital Organization.

  • Competing interests None.

  • Ethics approval This study was approved by the ethics committee at Shikoku Cancer Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • ▸ Additional data are published online only. To view this file please visit the journal online (