Abstract
Purpose: The aim of our study was to evaluate the different clinicopathological characteristics and prognostic factors for occult and non-occult breast cancer.Methods: 572 OBC cases and 117,217 non-OBC patients between 2004 and 2015 was selected from Surveillance, Epidemiology, and End Results (SEER) database. We analyzed the clinicopathological characteristics and survival outcomes between OBC and non-OBC patients. Furthermore, the propensity score matching method was utilized to reduce the influences of baseline differences in demographic and clinical characteristics on outcome differences. Univariable and multivariable analyses were used to evaluate the prognostic factors of OBC patients.Results: Compared with non-OBC patients, OBC patients in this study presented a higher proportion of older age, American Joint Committee on Cancer (AJCC) N3 stage, estrogen receptor (ER)-negative status, progesterone receptor (PR)-negative status, and human epidermal growth factor receptor-2 (HER-2)-positive status, and underwent more chemotherapy. Multivariate analysis revealed a better survival in overall patients with OBC patients according to breast cancer-specific survival (BCSS) and overall survival (OS). Propensity score analysis also achieved a similar result for OBC patients. Stratified analyses by nodal status and molecular subtypes indicated that these survival advantage were mainly presented in patients with AJCC N2/N3 stage or hormone receptor (HR)-positive tumors. In addition, nodal status, HER-2 status, and radiation status were demonstrated to be three independent prognostic factors for OBC patients.Conclusion: Patients with OBC retained exclusive clinical characteristics and were shown to have a better outcome compared with non-OBC patients, especially for those with N2/N3 stage or HR-positive tumors.
Highlights
Occult breast cancer (OBC) is a rare type of breast cancer which generally presents as axillary lymph node metastases without identified primary breast lesion
117,789 eligible patients were enrolled in our study, including 572 cases of OBC and 117,217 cases of non-OBC
In patients with N1 stage, the OBC patients demonstrated a better prognosis than non-OBC patients in terms of breast cancer-specific survival (BCSS) (HR = 0.661, 95% confidence intervals (CI) = 0.456–0.959, p = 0.029) but not Overall survival (OS)
Summary
Occult breast cancer (OBC) is a rare type of breast cancer which generally presents as axillary lymph node metastases without identified primary breast lesion. It is generally believed that OBC has a similar biological behavior compared with node-positive non-OBC, the clinicopathological characteristics of this disease are still unclear [6,7,8]. Some previous studies have indicated that the estrogen receptor (ER) status, triple negative subtype, and at least four positive lymph nodes were individual prognostic factors for occult breast cancer [6, 9,10,11]. Compared with non-OBC cases, OBC patients were shown to have a similar or less unfavorable outcome [12, 13], while the others have drawn contrary conclusions [14, 15]
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