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The Effect of Hospital Volume on Outcomes of Patients with Occult Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

With limited data in regards to management, occult breast cancer (OBC) poses a challenging surgical scenario. Current surgical management includes axillary lymphadenectomy (ALND) with or without mastectomy. We sought to investigate the impact of hospital volume on surgical approach and survival outcomes of patients with OBC.

Methods

Patients with cT0N+ breast cancer were selected from the National Cancer Data Base (NCDB, 2004–2014). Primary outcome was overall survival (OS), calculated using Kaplan–Meier methods compared according to hospital volume: community cancer center (CC), comprehensive community cancer center (COMP), and academic center (AC). Secondary outcome was the rate of modified radical mastectomy (MRM).

Results

We identified 574 patients with OBC, 11.1% were treated at a CC, 51.8% at a COMP, and 37.0% at an AC. Patients treated at CC had lower socioeconomic status compared with COMP or AC (23.1%, 14.1%, 19.3%; p = 0.005, respectively). There was no difference in access to radiation therapy (p = 0.888) or neoadjuvant chemotherapy (p = 0.221). Patients treated at CC had worse OS compared with COMP or AC (87.04, 105.29, 108.06 mo, p = 0.026, respectively). There was an increased rate of MRM at CC compared with COMP or AC (54.7%, 41.2%, 30.5%, p = 0.003, respectively).

Conclusions

A direct association seems to exist between hospital volume and outcomes of patients with OBC. Patients with OBC treated at AC were more likely to undergo breast-conserving approaches and had better survival than those treated at CC.

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Authors and Affiliations

  1. Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA

    Camille C. Baumrucker BS, Samantha R. Spring BS, Brianna L. Cohen MD & Dido Franceschi MD

  2. Division of Surgical Oncology, Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, FL, USA

    Janelle-Cheri Millen MD & Francis I. Macedo MD

Authors
  1. Camille C. Baumrucker BS
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  2. Samantha R. Spring BS
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  3. Brianna L. Cohen MD
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  4. Janelle-Cheri Millen MD
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  5. Francis I. Macedo MD
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  6. Dido Franceschi MD
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Correspondence to Camille C. Baumrucker BS.

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Baumrucker, C.C., Spring, S.R., Cohen, B.L. et al. The Effect of Hospital Volume on Outcomes of Patients with Occult Breast Cancer. Ann Surg Oncol 28, 2128–2135 (2021). https://doi.org/10.1245/s10434-020-09103-3

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  • DOI: https://doi.org/10.1245/s10434-020-09103-3

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