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

摘要

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 ? 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.