Treatment for occult breast cancer: A propensity score analysis of the National Cancer Database

Tsai, Catherine; Zhao, Beiqun; Chan, Theresa; Blair, Sarah L.

doi:10.1016/j.amjsurg.2019.11.023

Cited by 13 publications

(14 citation statements)

References 19 publications

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“…The speci city of 63% requires further con rmation by histological biopsy [31]. However, many patients only had LN metastasis without breast lesions, making it di cult to de ne their histologic tumor grade [12]. The routine application of breast MRI may alter the choice of the locoregional therapy for up to one-third of OBC patients [31] and may allow for BCT rather than mastectomy [32].…”

Section: Discussionmentioning

confidence: 99%

“…Recent retrospective studies and SEER population-based studies have mostly shown that OBC patients undergoing ALND alone or in combination with mastectomy or breast conserving therapy (BCT) shared similar treatment outcomes. Subsequent radiotherapy tends to improve prognosis, implying the probability of conservative treatment [7,[9][10][11][12][13]. Several series reported that patients with OBC had a better or similar outcome than that of the non-OBC patients [7,8,14], particularly for those with N2/3 stage or positive ER/PR tumors [6].…”

Section: Introductionmentioning

confidence: 99%

“…The study of Sohn et al partially conformed to our ndings, in which T0/TxN1 patients had better survival than T1N1 patients, while T0/TxN2, T0/TxN3 patients had similar survival to the matched T1 patients[4]. As an important survival determinant for BC, nodal stage potentially overweighs tumor size contributing to OBC patients' survival, suggested by the different prognostic values of T and N stage in our study.Most previous studies showed that OBC patients tended to retain positive ER and negative PR and HER2 status approached by the cohort population and SEER database [8,[11][12][13], among whichHuang et al [8] had enrolled up to 572 OBC out of the over 117 thousand BC patients. Our results, however, demonstrated…”

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confidence: 99%

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Mastectomy and Breast Conserving Therapy Share Comparable Survival and Efficacy on Patients with Occult Breast Cancer: A Retrospective Study in China

Jia

Ren

et al. 2022

Preprint

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Purpose This single-center retrospective study aimed to compare the efficacy of mastectomy and Breast Conserving Therapy (BCT) on overall survival (OS) and disease-free survival (DFS) and examine prognostic factors of Occult Breast Cancer (OBC) in China. Methods We conducted a univariate Kaplan-Meier analysis and a multivariate Cox proportional hazards model on OBC patients in Cancer Hospital, Chinese Academy of Medical Science (CHCAMS), comparing prognostic factors including treatment plans, risk factors, TNM stages, metastasis, and recurrence. Results Seventy patients with OBC undergoing axillary lymph node dissection (ALND) were included with median follow-up of 84.0 months. No statistically significant differences in OS (HR, 1.64; 95% CI, 0.59-4.51; p=0.327) and DFS (HR, 1.83; 95% CI, 0.60-4.89; p=0.200) were observed between mastectomy (n=23) and BCT (n=37). Positive estrogen receptor and progesterone receptor suggested better survival in univariate analysis. Patients with more severe N stage presented inferior survival. The association between radiotherapy and worse survival was probably because patients with higher TNM stages tended to receive radiotherapy. Low Ki-67 level (≤14%) predicted worse outcomes in both univariate and multivariate analyses. Conclusion Mastectomy with ALND presented comparable prognosis outcomes to BCT with ALND for OBC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Mastectomy and Breast Conserving Therapy Share Comparable Survival and Efficacy on Patients with Occult Breast Cancer: A Retrospective Study in China

Jia

Ren

et al. 2022

Preprint

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“…This is different from many other studies including our results, which have shown that surgical types did not impact prognosis of OBC patients. A clinical study based on National Cancer Database collected 190 patients diagnosed from 2004 to 2014 [23]. Treatment strategies included mastectomy alone, radiation alone and mastectomy combined with radiation.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Characteristics and Treatment Outcomes of Occult Breast Cancer: A Population-Based Study

Zhao

Zhang

et al. 2021

Preprint

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Background Occult breast cancer (OBC) is a special type of breast cancer. It is defined as an axillary lymph node metastasis without ipsilateral breast malignancy according to mammogram and ultrasonography. Because of its rarity and no primary lesion, clinicopathological information is still insufficient, causing a controversial condition about its treatment recommendation. In this study, we aimed to clarify major clinicopathological information, treatment strategies and prognosis of OBC based on a large population. Methods We retrospectively collected adult female OBC population from Surveillance, Epidemiology, and End Results (SEER) database. We divided the whole OBC cohort into two groups based on surgical treatment. Descriptive analysis of 18 clinicopathological variables was conducted by Wilcoxin rank sum test, Chi-square and Fisher’s exact test. Survival analysis was performed in the whole cohort as well as based on different clinicopathological factors. Univariate and multivariate Cox regression analysis was performed to identify potential independent predictor for prognosis of OBC. Results 1189 OBC patients was included in final analysis. Elderly patients predominated with a mean age of nearly 60. Most of the OBC patients were diagnosed as an early-stage carcinoma and ductal carcinoma took up nearly 40% of all the histological types of OBC. Luminal A is the commonest subtypes of OBC. For in-breast treatment, number of patients received mastectomy was 4 times more than that of patients received breast-conserving surgery (BCS). More than 70% patients receiving BCS took radiotherapy, significantly more than the portion of patients receiving radiation in mastectomy group (50.9%, P < 0.001). Median follow-up period of all subjects was about 62 months. 5-year and 10-year overall survival (OS) of the complete OBC cohort was 81.6% and 68.8%, respectively. No significant difference in OS and breast-cancer specific survival (BCSS) was found between mastectomy and BCS. Older age and larger number of positive lymph nodes causes a worse prognosis whereas radiotherapy brought a better clinical outcome for OBC patients. Conclusion OBC is a rare breast malignancy with a generally good prognosis. Less-intensive surgical intervention does not negatively impact clinical outcomes of OBC while additional radiotherapy is totally beneficial to prolong OS and BCSS.

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“…In patients with occult breast cancer, radiation therapy to the breast has been demonstrated to achieve an OS similar to total mastectomy (31), implying that omission of surgical excision of the occult primary tumour in the breast may not have a detrimental oncological impact. Surgical resection of the primary tumour was not mandatory in some of the trials that compared neoadjuvant and adjuvant chemotherapy.…”

Section: Can Breast Lumpectomy Be Safely Omitted?mentioning

confidence: 99%

De-Escalation of Breast Cancer Surgery Following Neoadjuvant Systemic Therapy

Wazir¹,

Mokbel²

2022

EJBH

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Breast cancer treatment has seen many advances in recent decades, lessening the morbidity to patients, while improving outcomes. Central to these gains has been the introduction of breast conserving surgery and neoadjuvant systemic therapy (NST). There is a considerable interest in further de-escalation of the treatment of breast cancer, which is being studied in several ongoing randomised trials. We aimed to appraise the current literature regarding the various aspects of de-escalation of surgical treatment of breast cancer after NST, and attempt to prognosticate the future course of breast oncotherapy.

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Treatment for occult breast cancer: A propensity score analysis of the National Cancer Database

Cited by 13 publications

References 19 publications

Mastectomy and Breast Conserving Therapy Share Comparable Survival and Efficacy on Patients with Occult Breast Cancer: A Retrospective Study in China

Mastectomy and Breast Conserving Therapy Share Comparable Survival and Efficacy on Patients with Occult Breast Cancer: A Retrospective Study in China

Clinicopathological Characteristics and Treatment Outcomes of Occult Breast Cancer: A Population-Based Study

De-Escalation of Breast Cancer Surgery Following Neoadjuvant Systemic Therapy

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