Evaluation of the Benefit of Radiotherapy in Patients with Occult Breast Cancer: A Population-Based Analysis of the SEER Database
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Purpose Few studies for occult breast cancer (OBC) have evaluated the effect of radiotherapy (RT) after mastectomy or axillary lymph node dissection (ALND) with/without breast surgery. Therefore, we investigated clinicopathologic factors of OBC with the impact of postoperative RT to determine its prognostic significance using large population-based data. Materials and Methods We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database from 1983 to 2013. A total of 1,045 eligible patients with OBC were identified. We compared overall survival (OS) using Cox proportional hazards regression with propensity score matching after verifying an imbalance of prognosticators between RT group (n=518) and non-RT group (n=479). Results Patients with age < 70 (p=0.033), married marital status (p < 0.001), undergoing ALND (p < 0.001), more examined lymph nodes (LNs) (p < 0.001), and more metastatic LNs (p < 0.001) were more likely to receive RT. Multivariate analysis after propensity score matching (n=798) showed that patients treated with RT survived significantly longer than those without RT (5-year OS, 81.5% vs. 78.3%; p=0.014). A significantly prolonged OS was observed when RT was given to patients treated with mastectomy (p=0.033), those treated with ALND (p=0.036), or those with more than seven metastatic LNs (p=0.016). Conclusion RT may offer survival benefit in OBC even after mastectomy or ALND, especially in patients with more than seven metastatic LNs. Further prospective studies are needed to validate these findings.
Abstract
Purpose Few studies for occult breast cancer (OBC) have evaluated the effect of radiotherapy (RT) after mastectomy or axillary lymph node dissection (ALND) with/without breast surgery. Therefore, we investigated clinicopathologic factors of OBC with the impact of postoperative RT to determine its prognostic significance using large population-based data. Materials and Methods We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database from 1983 to 2013. A total of 1,045 eligible patients with OBC were identified. We compared overall survival (OS) using Cox proportional hazards regression with propensity score matching after verifying an imbalance of prognosticators between RT group (n=518) and non-RT group (n=479). Results Patients with age < 70 (p=0.033), married marital status (p < 0.001), undergoing ALND (p < 0.001), more examined lymph nodes (LNs) (p < 0.001), and more metastatic LNs (p < 0.001) were more likely to receive RT. Multivariate analysis after propensity score matching (n=798) showed that patients treated with RT survived significantly longer than those without RT (5-year OS, 81.5% vs. 78.3%; p=0.014). A significantly prolonged OS was observed when RT was given to patients treated with mastectomy (p=0.033), those treated with ALND (p=0.036), or those with more than seven metastatic LNs (p=0.016). Conclusion RT may offer survival benefit in OBC even after mastectomy or ALND, especially in patients with more than seven metastatic LNs. Further prospective studies are needed to validate these findings.
참고문헌 (21)
- Patel J, "Axillary lymph node metastasis from an occult breast cancer", Cancer, 47, pp.2923~2927 (1981)[DOI]
- Walker GV, "Population-based analysis of occult primary breast cancer with axillary lymph node metastasis", Cancer, 116, pp.4000~4006 (2010)[DOI]
- [URL]
- Masinghe SP, "Breast radiotherapy for occult breast cancer with axillary nodal metastases: does it reduce the local recurrence rate and increase overall survival?", Clin Oncol (R Coll Radiol), 23, pp.95~100 (2011)[DOI]
- He M, "Treatment outcomes and unfavorable prognostic factors in patients with occult breast cancer", Eur J Surg Oncol, 38, pp.1022~1028 (2012)[DOI]
- Sohn G, "Treatment and survival of patients with occult breast cancer with axillary lymph node metastasis: a nationwide retrospective study", J Surg Oncol, 110, pp.270~274 (2014)[DOI]
- Rueth NM, "Breast conservation in the setting of contemporary multimodality treatment provides excellent outcomes for patients with occult primary breast cancer", Ann Surg Oncol, 22, pp.90~95 (2015)[DOI]
- Fayanju OM, "Geographic and temporal trends in the management of occult primary breast cancer: a systematic review and meta-analysis", Ann Surg Oncol, 20, pp.3308~3316 (2013)[DOI]
- Khandelwal AK, "Therapeutic options for occult breast cancer: a survey of the American Society of Breast Surgeons and review of the literature", Am J Surg, 190, pp.609~613 (2005)[DOI]
- Sagara Y, "Patient prognostic score and associations with survival improvement offered by radiotherapy after breast-conserving surgery for ductal carcinoma in situ: a population-based longitudinal cohort study", J Clin Oncol, 34, pp.1190~1196 (2016)[DOI]
- Orel SG, "Breast MR imaging in patients with axillary node metastases and unknown primary malignancy", Radiology, 212, pp.543~549 (1999)[DOI]
- Vlastos G, "Feasibility of breast preservation in the treatment of occult primary carcinoma presenting with axillary metastases", Ann Surg Oncol, 8, pp.425~431 (2001)[DOI]
- EBCTCG (Early Breast Cancer Trialists' Collaborative Group), "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, 383, pp.2127~2135 (2014)[DOI]
- Recht A, "Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update", Pract Radiat Oncol, 6, pp.e219~e234 (2016)[DOI]
- 박혜진, "Incorporating Risk Factors to Identify the Indication of Post-mastectomy Radiotherapy in N1 Breast Cancer Treated with Optimal Systemic Therapy: A Multicenter Analysis in Korea (KROG 14-23)", Cancer Research and Treatment, 49(3), pp.739~747 (2017), 대한암학회
- Barton SR, "The role of ipsilateral breast radiotherapy in management of occult primary breast cancer presenting as axillary lymphadenopathy", Eur J Cancer, 47, pp.2099~2106 (2011)[DOI]
- Shannon C, "Occult primary breast carcinoma presenting as axillary lymphadenopathy", Breast, 11, pp.414~418 (2002)[DOI]
- Ellerbroek N, "Treatment of patients with isolated axillary nodal metastases from an occult primary carcinoma consistent with breast origin", Cancer, 66, pp.1461~1467 (1990)[DOI]
- Blanchard DK, "Retrospective study of women presenting with axillary metastases from occult breast carcinoma", World J Surg, 28, pp.535~539 (2004)
- Macedo FI, "Optimal surgical management for occult breast carcinoma: a meta-analysis", Ann Surg Oncol, 23, pp.1838~1844 (2016)[DOI]
- 우상민, "Survival Outcomes of Different Treatment Methods for the Ipsilateral Breast of Occult Breast Cancer Patients with Axillary Lymph Node Metastasis: A Single Center Experience", Journal of Breast Cancer, 16(4), pp.410~416 (2013), 한국유방암학회