Rueth Natasha M, Black Dalliah M, Limmer Angela R, Gabriel Emmanuel, Huo Lei, Fornage Bruno D, Dogan Basak E, Chavez-MacGregor Mariana, Yi Min, Hunt Kelly K, Strom Eric A
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1484, Houston, TX, 77030, USA.
Ann Surg Oncol. 2015 Jan;22(1):90-5. doi: 10.1245/s10434-014-3991-0. Epub 2014 Sep 24.
To evaluate recurrence and survival for patients with occult (T0N+) breast cancer who underwent contemporary treatment, assessing outcomes for breast conservation and mastectomy.
We performed a single-institution review of women with occult breast cancer presenting with axillary metastasis without identifiable breast tumor or distant metastasis. We excluded patients with tumors in the axillary tail or mastectomy specimen, patients with additional nonbreast cancer diagnoses, and patients with a history of breast cancer. Breast conservation was defined as axillary node dissection with radiation therapy, without breast surgery. We evaluated patient, tumor, treatment, and outcome variables. Patients were assessed for local, regional, and distant recurrences. Overall survival was calculated using the Kaplan-Meier method.
Thirty-six patients met criteria for occult breast cancer. Most of these patients (77.8 %) had N1 disease. Fifty percent of cancers (n = 18) were estrogen receptor-positive; 12 (33.3 %) were triple-negative. All patients were evaluated with mammography. Thirty-five patients had breast ultrasound (97.2 %) and 33 (91.7 %) had an MRI. Thirty-four patients (94.4 %) were treated with chemotherapy and 33 (91.7 %) with radiotherapy. Twenty-seven patients (75.0 %) were treated with breast conservation. The median follow-up was 64 months. There were no local or regional failures. One distant recurrence occurred >5 years after diagnosis, resulting in a 5-years overall survival rate of 100 %. There were no significant survival differences between patients receiving breast conservation versus mastectomy (p = 0.7).
Breast conservation-performed with contemporary imaging and multimodality treatment-provides excellent local control and survival for women with T0N+ breast cancer and can be safely offered instead of mastectomy.
评估接受现代治疗的隐匿性（T0N+）乳腺癌患者的复发情况和生存率，比较保乳手术和乳房切除术的治疗效果。
我们对一家机构中出现腋窝转移但未发现乳腺肿瘤或远处转移的隐匿性乳腺癌女性患者进行了回顾性研究。我们排除了腋窝尾部或乳房切除标本中有肿瘤的患者、有其他非乳腺癌诊断的患者以及有乳腺癌病史的患者。保乳手术定义为腋窝淋巴结清扫加放疗，无需进行乳房手术。我们评估了患者、肿瘤、治疗和结局变量。对患者进行局部、区域和远处复发情况评估。采用Kaplan-Meier方法计算总生存率。
36例患者符合隐匿性乳腺癌标准。这些患者中大多数（77.8%）为N1期疾病。50%的癌症（n = 18）雌激素受体阳性；12例（33.3%）为三阴性。所有患者均接受了乳腺X线摄影检查。35例患者进行了乳腺超声检查（97.2%），33例（91.7%）进行了MRI检查。34例患者（94.4%）接受了化疗，33例（91.7%）接受了放疗。27例患者（75.0%）接受了保乳手术。中位随访时间为64个月。无局部或区域复发。1例远处复发发生在诊断后5年以上，5年总生存率为100%。接受保乳手术和乳房切除术的患者生存率无显著差异（p = 0.7）。
采用现代影像学检查和多模式治疗的保乳手术可为T0N+乳腺癌女性患者提供良好的局部控制和生存率，可安全地替代乳房切除术。
