AbstractPurposePhyllodes tumors (PTs) are rare neoplasms with a certain risk of recurrence and/or metastasis. In clinical practice, there is a lack of high‐quality clinical studies and unified guidelines to guide the treatment.Materials and MethodsAll malignant and recurrence/metastasis PTs were retrospectively collected, which were diagnosed from 2008 to 2022.ResultsA total of 82 patients were enrolled, including 69 malignant and 13 borderline tumors. 96.3% (79/82) received surgical treatment. During a median follow‐up of 55.5 months, 20 patients (20/82, 24.4%) had distant metastasis (DM), while 32 (32/82, 39.0%) had local recurrence (LR). Univariate analysis showed the survival of PTs was associated with surgical methods (p< 0.001), tumor size (p= 0.026), and biological behavior (p= 0.017), but not age at diagnosis. In relapsed borderline PTs, we did not find deaths due to disease progression. Patients with DM were all malignant PTs, with disease‐progression occurring within 3 years in more than 80% of patients. Among salvage treatments, the combination of antiangiogenic drugs improved the prognosis to some extent, with a significant increase in mPFS (2.77 vs. 1.53 months), but no significant statistical results were obtained (p= 0.168). Lactate dehydrogenase (LDH) was an independent predictor of the prognosis for malignant PTs (p= 0.001, HR = 1.203, 95%CI, 1.082–1.336).ConclusionBorderline PTs rarely metastasize, and even if LR occurs, surgical resection can lead to long‐term survival. In metastatic phyllodes tumors (MPT), systemic therapy is not effective, but antiangiogenic drugs may prolong survival. LDH is an independent prognostic factor for malignant PTs to identify high‐risk tumors.