Locoregional Lymph Node Metastasis from Clinically Occult Breast Cancer: Prognostic Significance of Mastectomy

IF 1.9 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Andreas Werner Nærum, Emil Villiam Holm-Rasmussen, Ilse Vejborg, Ann Søegaard Knoop, Anne-Vibeke Lænkholm, Niels Kroman, Tove Filtenborg Tvedskov
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Abstract

Background and Purpose. Occult breast cancer (OBC) is a rare condition. Due to the small number of patients in previous studies, the benefits of treatment with mastectomy are still discussed. This study aims to determine the clinicopathological characteristics, treatment, and prognosis of OBC presenting with locoregional lymph node metastasis (LNM). Materials and Methods. This study included patients registered in the national Danish Breast Cancer Group (DBCG) database between 2001 and 2015, with locoregional LNM as well as a bilateral negative mammography, ultrasonography, and physical examination of the breasts. Overall survival (OS) and invasive disease-free survival (IDFS) were compared by treatment groups, ALND + RT (axillary lymph node dissection and radiotherapy) or ALND + MAST ± RT (axillary lymph node dissection, mastectomy with or without radiotherapy). Results. In total, 56 patients were included in the study, of which 37 were treated by ALND + RT, 16 by ALND + MAST ± RT, and the remaining three patients receiving different treatments. The median follow-up for the 53 OBC patients sorted by treatment group was 12.2 years (interquartile range: 10.1 years; 15.3 years). There was no significant difference in OS or IDFS between the treatment groups, except for a subgroup of 46 (out of 53) patients without verified in situ lesions before treatment, where ALND + RT treatment showed an improved OS (log-rank p = 0.05). Conclusion. Treating OBC patients with ALND and radiotherapy resulted in a similar outcome as treatment with ALND and mastectomy. This supports omission of mastectomy in favor of radiotherapy of the breast in these patients.

Abstract Image

临床隐匿性乳腺癌的局部淋巴结转移:乳房切除术的预后意义
背景和目的。隐匿性乳腺癌(OBC)是一种罕见病。由于以往研究中的患者人数较少,乳房切除术治疗的益处仍有待讨论。本研究旨在确定伴有局部淋巴结转移(LNM)的隐匿性乳腺癌的临床病理特征、治疗和预后。材料与方法。本研究纳入了2001年至2015年期间在丹麦乳腺癌小组(DBCG)国家数据库中登记的患者,这些患者均伴有局部淋巴结转移,且双侧乳房X光检查、超声检查和乳房体格检查均为阴性。按ALND + RT(腋窝淋巴结清扫术和放疗)或ALND + MAST ± RT(腋窝淋巴结清扫术、乳房切除术加或不加放疗)治疗组比较了总生存期(OS)和无侵袭性疾病生存期(IDFS)。结果。共有56名患者参与了研究,其中37人接受了ALND + RT治疗,16人接受了ALND + MAST ± RT治疗,其余3人接受了不同的治疗。按治疗组别分类,53名OBC患者的中位随访时间为12.2年(四分位间范围:10.1年;15.3年)。治疗组之间的 OS 或 IDFS 无明显差异,只有 46 例(共 53 例)患者在治疗前未证实有原位病变,ALND + RT 治疗改善了其 OS(对数秩 P = 0.05)。结论用ALND和放疗治疗OBC患者的结果与用ALND和乳房切除术治疗的结果相似。这支持对这些患者不进行乳房切除术,而进行乳房放疗。
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来源期刊
Breast Journal
Breast Journal 医学-妇产科学
CiteScore
4.00
自引率
0.00%
发文量
47
审稿时长
4-8 weeks
期刊介绍: The Breast Journal is the first comprehensive, multidisciplinary source devoted exclusively to all facets of research, diagnosis, and treatment of breast disease. The Breast Journal encompasses the latest news and technologies from the many medical specialties concerned with breast disease care in order to address the disease within the context of an integrated breast health care. This editorial philosophy recognizes the special social, sexual, and psychological considerations that distinguish cancer, and breast cancer in particular, from other serious diseases. Topics specifically within the scope of The Breast Journal include: Risk Factors Prevention Early Detection Diagnosis and Therapy Psychological Issues Quality of Life Biology of Breast Cancer.
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