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Recurrence prediction for breast phyllodes tumours: validation of the Singapore nomogram in Korean women
  1. Jung Eun Choi1,
  2. Su Hwan Kang1,
  3. Puay Hoon Tan2,
  4. Young Kyung Bae3
  1. 1Department of Surgery, Yeungnam University College of Medicine, Daegu, The Republic of Korea
  2. 2Division of Pathology, Singapore General Hospital, Singapore
  3. 3Deparment of Pathology, Yeungnam University College of Medicine, Daegu, The Republic of Korea
  1. Correspondence to Dr Young Kyung Bae, Department of Pathology, Yeungnam University College of Medicine, Daegu 42415, The Republic of Korea; ykbae{at}


Aim The Singapore nomogram was developed to predict recurrence risk of phyllodes tumours (PTs) of the breast based on histological features of stromal atypia, stromal mitoses, stromal overgrowth and surgical margin status. We aimed to validate the utility of the Singapore nomogram in a Korean PT cohort.

Methods One hundred and twenty-four patients with Korean PT who underwent surgical resection between 1996 and 2015 were included in this study. Pathology reports and slides were reviewed to obtain histopathologic features and acquire Singapore nomogram scores. The probability of concordance between predicted and observed survivals by means of the Singapore nomogram was evaluated using a concordance index (C-index).

Results Of the 124 cases, 57 (46%) were diagnosed as benign, 50 (40.3%) as borderline and 17 (13.7%) as malignant. Recurrences occurred in 25 (20.2%) patients. Univariate analysis showed PTs with higher stromal mitotic counts, marked stromal cellularity, stromal overgrowth, positive surgical margin, marked stromal atypia or a malignant grade presented higher risks of recurrence. Multivariate analysis showed stromal mitoses and surgical margin status independently predicted recurrence-free survival. Patients with high nomogram scores were at greater risk of recurrence (HR=1.05, 95% CI: 1.02 to 1.07, p<0.001) with a C-index of 0.762.

Conclusion The Singapore nomogram provided a useful means of predicting PT outcomes in a Korean PT cohort.

  • breast neoplasms
  • statistics
  • pathology
  • surgical
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  • Handling editor Cheok Soon Lee.

  • Contributors Conceptualisation: YKB, PHT. Project administration: JEC. Supervision: YKB. Writing—original draft: JEC, SHK, YKB. Writing—review & editing: SHK, YKB, PHT. Approval of final manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement No data are available. This study does not include results of clinical trials.

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