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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Lindsay K. Hessler, Jason K. Molitoris, Paula Y. Rosenblatt, Emily C. Bellavance, Elizabeth M. Nichols, Katherine H.R. Tkaczuk, Steven J. Feigenberg, Soren M. Bentzen, and Susan B. Kesmodel declare no conflicts of interest.

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    Authors and Affiliations

    1. Division of General and Oncologic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA

      Lindsay K. Hessler MD, Emily C. Bellavance MD & Susan B. Kesmodel MD

    2. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA

      Soren M. Bentzen PhD, DMSc

    3. Division of Hematology and Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

      Paula Y. Rosenblatt MD & Katherine H. R. Tkaczuk MD

    4. Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA

      Jason K. Molitoris MD, PhD, Elizabeth M. Nichols MD & Steven J. Feigenberg MD

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    1. Lindsay K. Hessler MD
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    Correspondence to Susan B. Kesmodel MD.

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    Drs. Lindsay Hessler and Jason Molitoris have contributed equally to this article.

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    Hessler, L.K., Molitoris, J.K., Rosenblatt, P.Y. et al. Factors Influencing Management and Outcome in Patients with Occult Breast Cancer with Axillary Lymph Node Involvement: Analysis of the National Cancer Database. Ann Surg Oncol 24, 2907–2914 (2017). https://doi.org/10.1245/s10434-017-5928-x

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    • DOI: https://doi.org/10.1245/s10434-017-5928-x

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