Survival Outcomes of Different Treatment Methods for the Ipsilateral Breast of Occult Breast Cancer Patients with Axillary Lymph Node Metastasis: A Single Center Experience

Abstract

PurposeThis study compared the survival outcomes of different treatment methods for the ipsilateral breast of occult breast cancer (OBC) patients with axillary lymph node metastasis.MethodsA retrospective study was conducted in which forty OBC patients with axillary lymph node metastasis were identified out of 15,029 patients who had been diagnosed with a primary breast cancer at between 1992 and 2010. The patients were categorized into three treatment groups based on ipsilateral breast management: breast-conserving surgery (BCS) (n=17), mastectomy (n=12), and nonsurgical intervention with or without radiation therapy (No surgery with or without radiation therapy [No Op±RT]) (n=11). All patients underwent axillary lymph node dissection. Cases were evaluated based on treatment and potential prognostic factors with respect to overall survival (OS) and disease-free survival (DFS).ResultsDuring the follow-up period (median follow-up of 71.5 months), the overall OS and DFS were 76.9% and 74.9%, respectively. The 5-year treatment-specific OS was 72.0% for the BCS group, 74.0% for the mastectomy group, and 87.5% for the No Op±RT group (log-rank p=0.49). The 5-year DFS was 70.6% for the BCS group, 66.7% for the mastectomy group, and 90.9% for the No Op±RT group (log-rank p=0.36). Recurrence rates for the BCS and No Op±RT groups were 5.9% and 18.2%, respectively. Histologic grade and lymph node status were inversely correlated with DFS (log-rank p=0.04 and p<0.01, respectively).ConclusionThere was no difference in survival outcomes between the three treatment methods for the ipsilateral breast (mastectomy, BCS, and No Op±RT) of OBC patients with axillary lymph node metastasis. A large-scale multicenter study is needed to validate the results from this small retrospective study.

Evaluation of the Benefit of Radiotherapy in Patients with Occult Breast Cancer: A Population-Based Analysis of the SEER Database

“…Previous studies also reported similar findings. The 5-year OS of BCS, mastectomy, and no operation groups was 72.0%, 74.0%, and 87.5%, respectively, with no significant differences observed between them (p=0.49) in the study by Woo et al [ 21 ]. He et al [ 5 ] also demonstrated that there were no differences in survival rates between mastectomy, BCS, and no breast operation.…”

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

“…Also the present study reports relatively low incidence rate (0.17%) when compared to generally reported rate (0.3–1.0%), since we only included OBC with pathologically negative in‐breast lesion. Woo et al reported 0.33% of incidence rate of OBC in their single center study in Korea. Second, the study group is very heterogeneous regarding the local treatments such as the extent of surgery and radiotherapy.…”

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

“…None of the comparative studies have shown a significant increase in rates of locoregional recurrence in patients treated with WBRT as compared to MRM. 7,14,20,21 On meta-analysis, the rates of locoregional control, distant metastasis, and mortality are similar between patients who undergo MRM and those who have ALND and WBRT. 10 The addition of WBRT when the breast is preserved is an important component of the treatment, as its omission results in a significantly higher rate of locoregional recurrence due to failure to either excise or irradiate the breast primary and perhaps a worse long-term survival.…”

“…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 …”