Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2017

01-10-2017 | Breast Oncology

Factors Influencing Management and Outcome in Patients with Occult Breast Cancer with Axillary Lymph Node Involvement: Analysis of the National Cancer Database

Authors: Lindsay K. Hessler, MD, Jason K. Molitoris, MD, PhD, Paula Y. Rosenblatt, MD, Emily C. Bellavance, MD, Elizabeth M. Nichols, MD, Katherine H. R. Tkaczuk, MD, Steven J. Feigenberg, MD, Soren M. Bentzen, PhD, DMSc, Susan B. Kesmodel, MD

Published in: Annals of Surgical Oncology | Issue 10/2017

Login to get access

Abstract

Background

Occult breast cancer (OBC) is rare and optimal local–regional (LR) management has not been defined. Using a patient registry database, we examine factors associated with treatment and outcomes in OBC.

Methods

Female patients with cT0 N1/2 M0 BC were selected from the National Cancer Database (2004–2013) and categorized into four treatment groups: MAST = mastectomy with axillary lymph node dissection (ALND) ± radiation (RT); RT + ALND = RT with ALND, no breast surgery; ALND = ALND alone; OBS = no breast surgery, RT, or ALND. Patient characteristics and overall survival (OS) were compared between groups, and multivariable analysis was used to identify factors associated with treatment and OS.

Results

Among 2.03 million BC cases, 1853 females (0.09%) with cT0 N1/2 M0 disease were identified and 1231 patients were categorized into a treatment group: MAST = 592, RT + ALND = 342, ALND = 106, OBS = 191. On logistic regression, care at an academic center was associated with a higher likelihood of RT + ALND compared with MAST (odds ratio 2.03, 95% confidence interval [CI] 1.50–2.74, p < 0.001). Patients treated with RT + ALND had significantly better OS on univariate survival analysis compared with patients treated with MAST (hazard ratio [HR] 0.475, 95% CI 0.306–0.736, p = 0.001). RT + ALND was independently associated with OS on multivariable survival analysis (HR 0.509, 95% CI 0.321–0.808, p = 0.004), after adjusting for covariates.

Conclusions

Patients with OBC were more likely to undergo RT + ALND if they received care at an academic center. Patients treated with RT + ALND had significantly better OS compared with patients treated with MAST, after adjusting for covariates. This supports the use of RT + ALND as LR treatment for patients with OBC.
Appendix
Available only for authorised users
Literature
1.
Walker GV, Smith GL, Perkins GH, et al. Population-based analysis of occult primary breast cancer with axillary lymph node metastasis. Cancer. 2010;116(17):4000–4006.CrossRefPubMedPubMedCentral
2.
Macedo FI, Eid JJ, Flynn J, Jacobs MJ, Mittal VK. Optimal surgical management for occult breast carcinoma: a meta-analysis. Ann Surgical Oncol. 2016;23(6):1838–1844.CrossRefPubMed
3.
4.
5.
Bilimoria KY, Stewart AK, Winchester DP, Ko CY. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol. 2008;15(3):683–690.CrossRefPubMedPubMedCentral
6.
He M, Tang LC, Yu KD, et al. Treatment outcomes and unfavorable prognostic factors in patients with occult breast cancer. Eur J Surg Oncol. 2012;38(11):1022–1028.CrossRefPubMed
7.
Shannon C, Walsh G, Sapunar F, A’Hern R, Smith I. Occult primary breast carcinoma presenting as axillary lymphadenopathy. Breast. 2002;11(5):414–418.CrossRefPubMed
8.
Foroudi F, Tiver KW. Occult breast carcinoma presenting as axillary metastases. Int J Radiat Oncol Biol Phys. 2000;47(1):143–147.CrossRefPubMed
9.
Wang X, Zhao Y, Cao X. Clinical benefits of mastectomy on treatment of occult breast carcinoma presenting axillary metastases. Breast J. 2010;16(1):32–37.CrossRefPubMed
10.
Blanchard DK, Farley DR. Retrospective study of women presenting with axillary metastases from occult breast carcinoma. World J Surg. 2004;28(6):535–539.CrossRefPubMed
11.
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–1716.CrossRef
12.
McGale P. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383(9935):2127–2135.CrossRefPubMed
13.
Khandelwal AK, Garguilo GA. Therapeutic options for occult breast cancer: a survey of the American Society of Breast Surgeons and review of the literature. Am J Surg. 2005;190(4):609–613.CrossRefPubMed
14.
Rosen PP, Kimmel M. Occult breast carcinoma presenting with axillary lymph node metastases: a follow-up study of 48 patients. Hum Pathol. 1990;21(5):518–523.CrossRefPubMed
15.
Olson JA Jr, Morris EA, Van Zee KJ, Linehan DC, Borgen PI. Magnetic resonance imaging facilitates breast conservation for occult breast cancer. Ann Surg Oncol. 2000;7(6):411–415.CrossRefPubMed
16.
Buchanan CL, Morris EA, Dorn PL, Borgen PI, Van Zee KJ. Utility of breast magnetic resonance imaging in patients with occult primary breast cancer. Ann Surg Oncol. 2005;12(12):1045–1053.CrossRefPubMed
17.
Morris EA, Schwartz LH, Dershaw DD, van Zee KJ, Abramson AF, Liberman L. MR imaging of the breast in patients with occult primary breast carcinoma. Radiology. 1997;205(2):437–440.CrossRefPubMed
18.
de Bresser J, de Vos B, van der Ent F, Hulsewe K. Breast MRI in clinically and mammographically occult breast cancer presenting with an axillary metastasis: a systematic review. Eur J Surg Oncol. 2010;36(2):114–119.CrossRefPubMed
Metadata
Title
Factors Influencing Management and Outcome in Patients with Occult Breast Cancer with Axillary Lymph Node Involvement: Analysis of the National Cancer Database
Authors
Lindsay K. Hessler, MD
Jason K. Molitoris, MD, PhD
Paula Y. Rosenblatt, MD
Emily C. Bellavance, MD
Elizabeth M. Nichols, MD
Katherine H. R. Tkaczuk, MD
Steven J. Feigenberg, MD
Soren M. Bentzen, PhD, DMSc
Susan B. Kesmodel, MD
Publication date
01-10-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5928-x

Other articles of this Issue 10/2017

Annals of Surgical Oncology 10/2017 Go to the issue

Breast Oncology

Influence of Distance to Hospital and Insurance Status on the Rates of Contralateral Prophylactic Mastectomy, a National Cancer Data Base study

Breast Oncology

Expanded Gene Panel Use for Women With Breast Cancer: Identification and Intervention Beyond Breast Cancer Risk

Breast Oncology

Considerations for Clinicians in the Diagnosis, Prevention, and Treatment of Breast Cancer-Related Lymphedema, Recommendations from an Expert Panel: Part 2: Preventive and Therapeutic Options

Breast Oncology

Association Between Recurrence and Re-Excision for Close and Positive Margins Versus Observation in Patients with Benign Phyllodes Tumors

Breast Oncology

Keynote Address at the American Society of Breast Surgeons 18th Annual Meeting

Breast Oncology

Preoperative Panel Testing for Hereditary Cancer Syndromes Does Not Significantly Impact Time to Surgery for Newly Diagnosed Breast Cancer Patients Compared with BRCA1/2 Testing