Abstract: Objective To investigate the clinicopathological characteristics of benign, borderline, and malignant phyllodes tumor of the breast (PTB), and to explore the independent factors associated with recurrence and recurrence-free survival (RFS) in the overall cohort and across different pathological subgroups.Methods A total of 338 patients with PTB who were treated at the Affiliated Hospital of Xuzhou Medical University between January 2007 and January 2024 were enrolled and their clinical data were retrospectively analyzed. Their clinicopathological characteristics, recurrence and metastasis, and factors affecting recurrence-free survival were analyzed.Results Among the 338 patients with PTB, 12 experienced recurrence, including one patient with distant metastasis. Univariate survival analysis showed that recurrence-free survival was significantly associated with pathological classification, tumor size, mitotic count, and other factors (P<0.05). Multivariable Cox regression analysis indicated that tumor size was an independent prognostic factor for recurrence-free survival, particularly for tumors larger than 10 cm (HR=0.148, P= 0.02).Conclusions Tumor size is an independent factor associated with recurrence in patients with PTB, and tumors larger than 10 cm are associated with a markedly increased risk of recurrence. Surgical approach appears to have no significant impact on prognosis. However, for high-risk tumors characterized by very large size and high mitotic activity, clinicians should exercise caution and consider a more extensive surgical approach.