Cancer Genetics and Epigenetics 2017, Vol.5, No.3, 11-16
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6 Treatment
6.1 Local treatment
6.1.1 Mastectomy+Axillary lymph node dissection (ALND)
Axillary lymph node metastasis of breast cancer advocate the use of traditional modified radical mastectomy for
breast cancer (Auchincloss surgery) and postoperative adjuvant chemotherapy, endocrine therapy and
corresponding targeted therapy. Modified radical mastectomy should be performed for patients with higher TNM
stage and / or high risk.
6.1.2 Axillary lymph node dissection combined with postoperative radiotherapy (ALND+X-ray Technique, XRT)
The 5 year survival rate was 72% and the 10 year survival rate was 66% of OBC after radiotherapy, respectively.
The study showed that patients with radiotherapy had lower ipsilateral breast tumor recurrence rates, local
recurrence rates, and higher total survival rate (Barton et al., 2011; Masinghe et al., 2011) when compared with
those untreated by radiotherapy patients. In the Francisco B review article, Meta analysis showed that there was
no significant difference between ALND+mastectomy and ALND+XRT in the local recurrence rate, distant
metastasis and mortality, which manifested that mastectomy can be replaced by radiotherapy in OBC patients after
undergoing ALND (Inatome et al., 2016). However, the mortality and local recurrence of ALND+XRT are better
than those of ALND alone. Therefore, it suggests that ALND combined with XRT may be the best choice for
surgical treatment of occult breast cancer (Macedo et al., 2016).
6.1.3 Axillary lymph node dissection alone (ALND)
It is feasible to combine the operation of breast conserving with ALND alone in patients who no primary foci of
the breast .One is the only axillary lymph node dissection (breast conserving 1 type); another is breast quadrant
resection, resection of suspected cancer and the surrounding areas of at least 1 cm to expand the scope of resection
or quadrant resection (breast conserving 2 type).Walker reviewed the prognosis of the above operation was
evaluated. There was no significant difference in the 10 year survival rate between the modified radical
mastectomy group and the breast conserving 1 group, but breast conserving 2 group was significantly lower than
those two groups. Breast conserving surgery should be used cautiously (Walker et al., 2010) for patients with
diffuse growth of OBC. There was no significant difference in total survival rate and disease-free survival rate
between ALND+mastectomy, ALND+XRT and ALND alone (Wang et al., 2013).
6.2 Systemic therapy
According to the NCCN guide, hormone receptor positive patients should be treated with endocrine therapy.
HER-2 positive patients are treated with adjuvant targeting, but should considered economic reasons. According
to study by Wang et al. (2011), the effect of combined radiotherapy and chemotherapy is much better than that of
simple treatment. Therefore, we should make reasonable and integrate strategy of radiotherapy, chemotherapy,
targeted therapy and endocrine therapy.
7 Prognosis
The prognosis of OBC became worse according with more lymph nodes, what’s more, hormone receptor, HER-2
gene amplification(Xin et al., 2014), cancer pathological types, the number of axillary lymph nodes, whether the
occurrence of supraclavicular metastasis are related to prognosis of OBC. In a retrospective analysis of Guiyun
Sohn M D, it is shown that lymph node status and tumor size do not have much effect on the survival rate of
patients when the lymph node staging is relatively late. This is also irrelevant with the malignant results of occult
breast cancer (Guiyun et al., 2014). Therefore, there was no difference between the five year survival rate and ten
year survival rate of OBC and N-OBC in stage
Ⅲ
(Sun et al., 2014).
Authors’ contributions
Z.D.W. read and approved the final manuscript. G.Z.F. wrote and translated the manuscript. Z.Z.W, L.W.Q, Y.S.R, Z.J.Y and Z.B.Z
collected materials. All authors read and approved the final manuscript.
