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

Zhao, Zijun; Zhang, Ting; Yao, Yu; Lü, Xin

doi:10.1186/s12893-022-01472-8

Cited by 11 publications

(13 citation statements)

References 24 publications

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“…In the previous studies, among the subtypes of OBC, the luminal A subtype was the most common (27.40%) while HER-2 positive OBC merely accounted for about 6.20% ( 8 ). The subtypes of IHC of OBC showed no significant difference in prognosis.…”

Section: Discussionmentioning

confidence: 88%

Case report: Unique ultrasound feature of thyroid metastases in occult breast cancer

et al. 2022

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Occult breast cancer is an uncommon type of breast cancer. Metastases of occult breast cancer to other tissues are rather rare. We present a rare case of thyroid metastases in a 46-year-old woman who underwent occult breast cancer. The first ultrasound (US) examination of the thyroid showed that the left lobe was enlarged but had normal thyroid function. At first, this case was misdiagnosed as thyroiditis based on the thyroid US features. However, the cytological and histological results showed that nests of the neoplastic cells were found. Further immunohistochemistry results confirmed that these neoplasms were derived from breast tissue. Analysis using the successive US scans revealed that the sizes and echo of the thyroid repeatedly changed after the radiotherapy and chemotherapy treatment. To our knowledge, this is the first reported case of occult breast carcinoma presenting with thyroid metastases. This case can easily be misdiagnosed as thyroiditis due to the metastasis area not manifesting as regular suspicious nodules or diffused punctate calcifications.

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Section: Discussionmentioning

confidence: 88%

Case report: Unique ultrasound feature of thyroid metastases in occult breast cancer

et al. 2022

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“…Previous studies have shown that local therapy provides a survival benefit for OBC patients (8,13,19,20); however, the benefit does not change significantly based on the type of local therapy. In contrast to our results, a retrospective study, which also used data from the SEER database, suggested that there was no difference in the prognosis of all N stage OBC patients who received radiotherapy and surgery (6).…”

Section: Discussionmentioning

confidence: 94%

“…Thus, combined ALND and adjuvant radiotherapy should be considered the primary treatment modality for such patients. A recent study based on the SEER database concluded that the type of surgery does not affect the prognosis of OBC patients and additional radiotherapy provides a survival benefit for OBC patients ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Survival analysis and nomogram for early-stage occult breast cancer with positive lymph nodes based on the SEER database

Man¹,

Han²,

Wang³

et al. 2022

Ann Transl Med

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Background: Occult breast cancer (OBC) is a rare type of breast cancer, which accounts for 0.3-1.0% of all breast cancers. However, the treatment of OBC remains controversial, especially the local treatment. We aimed to analyze the impact of different treatment and N stage on survival in early-stage OBC patients, and construct a nomogram to predict the prognosis. Methods:The data of patients with early-stage breast cancer were obtained from 17 registries in the Surveillance, Epidemiology, and End Results (SEER) database. Patient characteristics and breast cancerspecific survival (BCSS) were compared among the groups. Cox proportional risk models were used for both the univariate and multivariate analyses. Variables with a P value <0.07 in the univariate analysis were included in the multivariate analysis. The independent prognostic factors were included in the nomogram and validated internally.Results: A total of 492 early-stage OBC patients were randomized at a 7:3 ratio into the training cohort (n=348) and the testing cohort (n=144). N2+ stage patients had a worse prognosis than N1 stage patients (P=0.0051). Triple-negative breast cancer (TNBC) patients had the worst prognosis. Early-stage OBC patients benefited from surgery (P=0.0093) and radiotherapy (P=0.0102), but not chemotherapy (P=0.4030).An analysis of OBC patients with different N stages showed that in terms of treatment, N1 stage patients benefited from surgery (P=0.023), but did not benefit significantly from radiotherapy (P=0.0793), whereas N2+ stage patients benefited from radiotherapy (P=0.0098), but the benefit from surgery was not significant (P=0.1005). In the multivariate analysis, N stage, surgery, and radiotherapy remained statistically significant.Based on the results of the multivariate analysis, we constructed a nomogram for estimating the 3-and 5-year BCSS of OBC patients. The concordance index and the calibration plots show that our nomogram had sufficient accuracy and good coordination.Conclusions: N stage, surgery, and radiotherapy were identified as independent prognostic factors for OBC. We successfully constructed a nomogram using these independent risk factors and demonstrated that it could help predict the 3-and 5-year BCSS of OBC patients. Further data analyses need to be conducted to revise the treatment of early-stage OBC.

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“…Since this type of breast cancer is quite rare, its prognosis remains debatable, and standardized management of OBC is still difficult [1,6]. Some large-sample retrospective studies using SEER could help solve the problem of rare cases, but most such cases in previous studies have a large time span [7,20,21] and some cases that were not OBC might have been considered so in the past because of the limitations of imaging technology [6,32,33]. The present study, as far as we are aware, is the most up-to-date one to examine the clinical traits and prognosis of OBC patients.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it has been challenging to conduct randomized controlled trials and standardize management because this particular type of breast cancer is extremely rare. A lot of retrospective studies focus on the effect of different treatment methods on the prognosis of all OBC patients [7,[17][18][19][20][21], but no one has analyzed it in relation to different molecular subtypes, hence there is a need for a further inquiry.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Models Using Machine Learning Algorithms and Treatment Outcomes of Occult Breast Cancer Patients

Liu

et al. 2023

JCM

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Background: Occult breast cancer (OBC) is an uncommon malignant tumor and the prognosis and treatment of OBC remain controversial. Currently, there exists no accurate prognostic clinical model for OBC, and the treatment outcomes of chemotherapy and surgery in its different molecular subtypes are still unknown. Methods: The SEER database provided the data used for this study’s analysis (2010–2019). To identify the prognostic variables for patients with ODC, we conducted Cox regression analysis and constructed prognostic models using six machine learning algorithms to predict overall survival (OS) of OBC patients. A series of validation methods, including calibration curve and area under the curve (AUC value) of receiver operating characteristic curve (ROC) were employed to validate the accuracy and reliability of the logistic regression (LR) models. The effectiveness of clinical application of the predictive models was validated using decision curve analysis (DCA). We also investigated the role of chemotherapy and surgery in OBC patients with different molecular subtypes, with the help of K-M survival analysis as well as propensity score matching, and these results were further validated by subgroup Cox analysis. Results: The LR models performed best, with high precision and applicability, and they were proved to predict the OS of OBC patients in the most accurate manner (test set: 1-year AUC = 0.851, 3-year AUC = 0.790 and 5-year survival AUC = 0.824). Interestingly, we found that the N1 and N2 stage OBC patients had more favorable prognosis than N0 stage patients, but the N3 stage was similar to the N0 stage (OS: N0 vs. N1, HR = 0.6602, 95%CI 0.4568–0.9542, p < 0.05; N0 vs. N2, HR = 0.4716, 95%CI 0.2351–0.9464, p < 0.05; N0 vs. N3, HR = 0.96, 95%CI 0.6176–1.5844, p = 0.96). Patients aged >80 and distant metastases were also independent prognostic factors for OBC. In terms of treatment, our multivariate Cox regression analysis discovered that surgery and radiotherapy were both independent protective variables for OBC patients, but chemotherapy was not. We also found that chemotherapy significantly improved both OS and breast cancer-specific survival (BCSS) only in the HR−/HER2+ molecular subtype (OS: HR = 0.15, 95%CI 0.037–0.57, p < 0.01; BCSS: HR = 0.027, 95%CI 0.027–0.81, p < 0.05). However, surgery could help only the HR−/HER2+ and HR+/HER2− subtypes improve prognosis. Conclusions: We analyzed the clinical features and prognostic factors of OBC patients; meanwhile, machine learning prognostic models with high precision and applicability were constructed to predict their overall survival. The treatment results in different molecular subtypes suggested that primary surgery might improve the survival of HR+/HER2− and HR−/HER2+ subtypes, however, only the HR−/HER2+ subtype could benefit from chemotherapy. The necessity of surgery and chemotherapy needs to be carefully considered for OBC patients with other subtypes.

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

Cited by 11 publications

References 24 publications

Case report: Unique ultrasound feature of thyroid metastases in occult breast cancer

Case report: Unique ultrasound feature of thyroid metastases in occult breast cancer

Survival analysis and nomogram for early-stage occult breast cancer with positive lymph nodes based on the SEER database

Prognostic Models Using Machine Learning Algorithms and Treatment Outcomes of Occult Breast Cancer Patients

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