Radiat Oncol J.  2021 Jun;39(2):107-112. 10.3857/roj.2021.00241.

Prognosis of patients with axillary lymph node metastases from occult breast cancer: analysis of multicenter data

Affiliations
  • 1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 2Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 3Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea
  • 4Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
  • 5Department of Radiation Oncology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
  • 6Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
  • 7Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Korea
  • 8Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Korea

Abstract

Purpose
This study was conducted to evaluate prognosis of patients with level I/II axillary lymph node metastases from occult breast cancer (OBC).
Materials and Methods
Data of 53 patients with OBC who received axillary lymph node dissection (ALND) positive/negative (+/–) breast-conserving surgery between 2001 and 2013 were retrospectively collected at seven hospitals in Korea. The median number of positive lymph nodes (+LNs) was 2. Seventeen patients (32.1%) had >3 +LNs. A total of 48 patients (90.6%) received radiotherapy. Extents of radiotherapy were as follows: whole-breast (WB; n = 11), regional lymph node (RLN; n = 2), and WB plus RLN (n = 35).
Results
The median follow-up time was 85 months. Recurrence was found in four patients: two in the breast, one in RLN, and one in the breast and RLN. The 5-year and 7-year disease-free survival (DFS) rates were 96.1% and 93.5%, respectively. Molecular subtype and receipt of breast radiotherapy were significantly associated with DFS. Patients with estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 negative (ER-/PR-/HER2-) subtype had significantly lower 7-year DFS than those with non-ER-/PR-/HER2- tumor (76.9% vs. 100.0%; p = 0.03). Whole breast irradiation (WBI) was significantly associated with a higher 7-year DFS rate (94.7% for WBI group vs. 83.3% for non-WBI group; p = 0.01). Other factors including patient’s age, number of +LNs, taxane chemotherapy, and RLN irradiation were not associated with DFS.
Conclusion
Patients with OBC achieved favorable outcome after ALND and breast-targeting treatment. Molecular subtype and receipt of WBI was significant factors for DFS.

Keyword

Unknown primary neoplasms; Breast neoplasm; Lymph nodes; Radiotherapy
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