Treatment and survival of patients with occult breast cancer with axillary lymph node metastasis: A nationwide retrospective study

Sohn, Guiyun; Son, Byung Ho; Lee, Soo Jung; Kang, Eun Young; Jung, Sung Hoo; Cho, Se-Heon; Baek, Seunghee; Lee, Yu Ra; Kim, Hee Jung; Ko, Beom Suk; A, Yu; Lee, Jong Won; Ahn, Sei‐Hyun

doi:10.1002/jso.23644

Cited by 49 publications

(58 citation statements)

References 28 publications

(53 reference statements)

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“… 1 – 3 Although OBC has been described as having a natural history and biological behavior similar to that of node-positive non-OBC, 4 , 5 the clinicopathological characteristics of OBC, such as the hormone status, the HER2 status, and the LN involvement, are still unclear due to the rarity of this type of cancer. 6 – 8 Furthermore, the survival outcomes of patients with OBC are still controversial. The 10-year overall survival (OS) rate varies from 47.5% to 67.1%.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological characteristics and treatment outcomes of occult breast cancer: a SEER population-based study

Ge¹,

Liu²,

Xiao³

et al. 2018

CMAR

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BackgroundOccult breast cancer (OBC) is a rare type of breast cancer that has not been well studied. The clinicopathological characteristics and treatment recommendations for OBC are based on a limited number of retrospective studies and thus remain controversial.Patients and methodsWe identified 479 OBC patients and 115,739 non-OBC patients from 2004 to 2014 in and the Surveillance, Epidemiology, and End Results (SEER) database. The clinicopathological characteristics and survival outcomes were compared between OBC and non-OBC patients. We used the propensity score 1:1 matching analysis to evaluate OBC vs non-OBC comparison using balanced groups with respect to the observed covariates. We further divided the OBC population into four groups based on different treatment strategies. Univariable and multivariable analyses were used to calculate and compare the four treatment outcomes within the OBC population.ResultsOBC patients were older, exhibited a more advanced stage, a higher rate of negative estrogen receptor and progesterone receptor status, a higher rate of HER2-positive status, and a higher rate of ≥10 positive lymph nodes, and were less likely to undergo surgical treatment than non-OBC patients. After adjustments for clinicopathological factors, the OBC patients exhibited a significantly better survival than the non-OBC patients (P<0.001). This result was confirmed in a 1:1 matched case–control analysis. Within the four OBC treatment groups, we observed no difference in survival among the mastectomy group, the breast-conserving surgery (BCS) group, and the axillary lymph node dissection (ALND)-only group. The multivariable analysis revealed that the sentinel lymph node dissection-only group had the worst prognosis (P<0.001). Conclusion: OBC has unique clinicopathological characteristics and a favorable prognosis compared with non-OBC. BCS plus ALND and radiotherapy showed a survival benefit that was similar to that of mastectomy for OBC patients.

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Section: Introductionmentioning

confidence: 99%

Clinicopathological characteristics and treatment outcomes of occult breast cancer: a SEER population-based study

Ge¹,

Liu²,

Xiao³

et al. 2018

CMAR

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“…Our subtype findings are similar to those in previously published occult breast cancer cohorts with rates of ER negativity ranging from 32% to 63% and triple-negative disease reported in 18% to 33% of cases. 10,20,22,26 …”

Section: Discussionmentioning

confidence: 99%

Oncologic Outcomes After Treatment for MRI Occult Breast Cancer (pT0N+)

et al. 2017

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Background Studies assessing outcomes in occult breast cancer have often included women treated before the routine use of MRI. We undertook to examine outcomes in patients presenting with axillary adenopathy and no primary detectable on MRI or other imaging modalities. Methods All patients with axillary nodal metastases consistent with breast carcinoma, and no detectable breast primary on physical exam, mammography, or MRI treated between 1/1/1996 and 6/30/2011 were identified from an institutional database. Data was collected on local, regional, and distant recurrences. Results Thirty-eight patients were identified. Modified radical mastectomy (MRM) was performed in 13, while 25 underwent axillary dissection (ALND) and whole-breast radiotherapy (WBRT). Most women had pathological N1 disease (median number of positive nodes 2 [MRM cohort] and 3 [ALND+WBRT cohort], p=0.38). All patients received chemotherapy, with 30 of the 38 patients (79%) treated receiving an anthracycline and taxane. Regional nodal radiation was used in 60% of those with ALND+WBRT and in all of the 46% of MRM patients who received chest wall radiotherapy. At a median follow up of 7 years, there were no nodal recurrences. Two patients treated with ALND+WBRT developed in-breast recurrences; none in the MRM group developed local recurrence. The proportion that developed distant disease was similar between the MRM cohort (1 of 13) and the ALND+WBRT cohort (2 of 25). Conclusion Breast cancer presenting as axillary adenopathy but no detectable primary is rare. Breast conservation with WBRT is a viable option for patients diagnosed with occult breast cancer and a negative preoperative MRI.

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“…There is no large multiinstitutional and international studies done to determine optimal therapy; most treatment are based on clinical trials in female OBC and the group had been recommended mastectomy and axillary lymph nodes resection as the preferred surgical strategy for a long time. 11 , 12 Currently, the National Comprehensive Cancer Network guidelines point out either mastectomy with axillary lymph node resection or axillary lymph nodes resection with whole-breast irradiation for T0, N1, and M0 stage, and systemic chemotherapy, endocrine therapy, combined with surgery for Stages II and III disease. 13 …”

Section: Discussionmentioning

confidence: 99%

A Case Report of Male Occult Breast Cancer First Manifesting as Axillary Lymph Node Metastasis With Part of Metastatic Mucinous Carcinoma

Jiang

2015

Medicine

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Treatment and survival of patients with occult breast cancer with axillary lymph node metastasis: A nationwide retrospective study

Abstract: OBC patients treated with ALND only showed comparable outcomes to those undergoing ALND combined with BCS or mastectomy. Nodal status may be an independent predictor of poor outcome in OBC patients.

Cited by 49 publications

References 28 publications

Clinicopathological characteristics and treatment outcomes of occult breast cancer: a SEER population-based study

Clinicopathological characteristics and treatment outcomes of occult breast cancer: a SEER population-based study

Oncologic Outcomes After Treatment for MRI Occult Breast Cancer (pT0N+)

A Case Report of Male Occult Breast Cancer First Manifesting as Axillary Lymph Node Metastasis With Part of Metastatic Mucinous Carcinoma

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