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Surgical treatment trends and identification of primary breast tumors after surgery in occult breast cancer: a study based on the Japanese National Clinical Database—Breast Cancer Registry

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Abstract

Background

Occult breast cancer (OBC) is classified as carcinoma of an unknown primary site, and the adequate therapy for OBC remains controversial. This retrospective study aimed to reveal the transition in breast cancer therapy and the frequency of primary breast tumors after resection in clinical OBC (cT0N+) patients using the Japanese Breast Cancer Registry database.

Methods

We enrolled OBC patients with cT0N+ from the registry between 2010 and 2018. On the basis of the period of diagnosis, OBC patients were divided into the following two groups: 2010–2014 and 2015–2018. We described the transition in treatments and tumor characteristics. After breast resection, the frequency of pathological identification of primary tumors and tumor sizes was assessed.

Results

Of the 687,468 patients registered, we identified 148 cT0N+ patients with a median age of 61 years. Of these patients, 64.2% (n = 95) received breast surgery (2010–2014: 79.1%, 2015–2018: 50.0%). Axillary lymph node dissection was performed in 92.6% (n = 137, 2010–2014: 91.6%, 2015–2018: 93.4%). The breast tumor size in the resected breast was 0–7.0 cm (median: 0 cm, 2010–2014: 0–7.0 cm [median: 0 cm], 2015–2018: 0–6.2 cm [median: 0 cm]). The pathological identification rate of the primary tumor was 41.1% (n = 39, 2010–2014: 40.4%, 2015–2018: 42.1%).

Conclusions

Breast surgery for cT0N+ decreased between 2010 and 2018. Despite the high identification rate of primary tumors, most tumors were small, and there was no significant change in the identification rate or invasive diameter of the identified tumors after 2010.

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Acknowledgements

We would like to thank the JBCS staff and National Clinical Database office staff for their support in this study. MT would like to thank Yayoi Adachi and Hiroji Iwata at Aichi Cancer Center for their support in the application of this research proposal. We thank Melissa Crawford, PhD, from Edanz (https://en-author-services.edanz.com/ac) for editing a draft of this manuscript.

Funding

This work was supported by the Japanese Breast Cancer Society.

Author information

Authors and Affiliations

  1. Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan

    Mitsuo Terada

  2. Department of Breast and Endocrine Surgical Oncology, Tohoku University School of Medicine, Sendai, Japan

    Minoru Miyashita

  3. Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan

    Hiraku Kumamaru & Hiroaki Miyata

  4. Department of Medical Oncology, Shimane University Hospital, Shimane, Japan

    Kenji Tamura

  5. Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan

    Masayuki Yoshida

  6. Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan

    Etsuyo Ogo

  7. Department of Breast and Endocrine Surgery, Hyogo College of Medicine, Hyogo, Japan

    Masayuki Nagahashi

  8. Department of Breast Surgery, Kyorin University School of Medicine, Tokyo, Japan

    Sota Asaga

  9. Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, Kawasaki, Japan

    Yasuyuki Kojima

  10. Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Takayuki Kadoya

  11. Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan

    Kenjiro Aogi

  12. Department of Breast and Endocrine Surgery, Tokai University School of Medicine, Kanagawa, Japan

    Naoki Niikura

  13. Department of Breast Oncology, Juntendo University, Tokyo, Japan

    Kotaro Iijima

  14. Department of Breast Surgical Oncology, St. Luke’s International Hospital, Tokyo, Japan

    Naoki Hayashi

  15. Department of Surgery and Oncology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan

    Makoto Kubo

  16. Department of Molecular-Targeting Therapy for Breast Cancer, Kumamoto University, Kumamoto, Japan

    Yutaka Yamamoto

  17. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan

    Hiromitsu Jinno

Authors
  1. Mitsuo Terada
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  2. Minoru Miyashita
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  3. Hiraku Kumamaru
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  4. Hiroaki Miyata
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Contributions

MT, MM, HK, HM, KT, MY, EO MD, MN, SA, YK, TK, KA, NN, KI, NH MK, YY, and HJ were involved in study design and data interpretation. MT, MM and HM were involved in the data analysis. All authors critically revised the report, commented on drafts of the manuscript, and approved the final report.

Corresponding author

Correspondence to Mitsuo Terada.

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Conflict of interest

HK, and HM are affiliated with the Department of Healthcare Quality Assessment at The University of Tokyo, which is a social collaboration department supported by the National Clinical Database, Johnson & Johnson K.K., and Nipro Corporation. MT, MM, KT, MY, EO MD, MN, SA, YK, TK, KA, NN, KI, NH MK, YY, and HJ declare no conflicts of interest associated with this manuscript.

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Terada, M., Miyashita, M., Kumamaru, H. et al. Surgical treatment trends and identification of primary breast tumors after surgery in occult breast cancer: a study based on the Japanese National Clinical Database—Breast Cancer Registry. Breast Cancer 29, 698–708 (2022). https://doi.org/10.1007/s12282-022-01348-y

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  • DOI: https://doi.org/10.1007/s12282-022-01348-y

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