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Population-based analysis of occult primary breast cancer with axillary lymph node metastasis
Article first published online: 19 AUG 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 17, pages 4000–4006, 1 September 2010
How to Cite
Walker, G. V., Smith, G. L., Perkins, G. H., Oh, J. L., Woodward, W., Yu, T.-K., Hunt, K. K., Hoffman, K., Strom, E. A. and Buchholz, T. A. (2010), Population-based analysis of occult primary breast cancer with axillary lymph node metastasis. Cancer, 116: 4000–4006. doi: 10.1002/cncr.25197
- Issue published online: 23 AUG 2010
- Article first published online: 19 AUG 2010
- Manuscript Accepted: 23 NOV 2009
- Manuscript Revised: 11 NOV 2009
- Manuscript Received: 20 OCT 2009
- occult breast cancer;
- axillary lymph node metastasis;
- breast-conserving therapy;
- End Results
Single-institution data suggest that treatment with radiation and axillary lymph node dissection (ALND) may be an appropriate alternative to mastectomy for T0N+ breast cancer. Population-based multi-institutional data supporting this approach are lacking.
The cause-specific survival (CSS) and overall survival (OS) of women with T0N+M0 ductal, lobular, or mixed breast cancer in the Surveillance, Epidemiology, and End Results database from 1983 to 2006 were analyzed. Groups were defined as: 1) no ALND, mastectomy, or RT (observation); 2) ALND only; 3) mastectomy plus ALND with or without postmastectomy radiation (Mast); and 4) breast-conserving therapy (BCT) with ALND and radiation (BCT).
In total, 750 of 770,030 patients with breast cancer had T0N+M0 disease (incidence, 0.10%), and 596 of those patients underwent ALND (79.5%). Patients who underwent Mast or BCT (n = 470) had a 10-year OS rate of 64.9% compared with 58.5% for patients who underwent ALND only (n = 126; P = .02) and 47.5% for patients who underwent observation only (n = 94; P = .04). The 10-year CSS rate was 75.7% for patients who underwent BCT versus 73.9% for patients who underwent Mast (P = .55). In multivariate analysis of CSS for patients who underwent Mast or BCT, the following factors were correlated with an unfavorable outcome: positive estrogen receptor status (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.24-0.96; P = .04), ≥10 positive lymph nodes (HR, 5.7; 95%CI, 2.4-13.4; P ≤ .01), and <10 resected lymph nodes (HR, 42.9; 95%CI, 1.2-7.1; P = .02). Mast did not improve CSS compared with BCT (HR, 1.09; 95%CI, 0.57-2.1; P = .79).
Definitive locoregional treatment with either Mast or BCT improved the outcome of patients with T0N+breast cancer, and no difference in survival was observed between the treatments. Cancer 2010. © 2010 American Cancer Society.