Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jan 19, 2024; 14(1): 76-87
Published online Jan 19, 2024. doi: 10.5498/wjp.v14.i1.76
Clinicopathological features, psychological status, and prognosis of 33 patients with occult breast cancer
Hong-Mei Wang, Ao-Yang Yu, Lin-Lin Li, Lu-Yao Ma, Meng-Han Cao, Yu-Le Yang, Xiao-Bing Qin, Juan-Juan Tang, Zheng-Xiang Han
Hong-Mei Wang, Meng-Han Cao, Xiao-Bing Qin, Juan-Juan Tang, Zheng-Xiang Han, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Ao-Yang Yu, Lu-Yao Ma, Yu-Le Yang, Graduate School, Xuzhou Medical University, Xuzhou 221004, Jiangsu Province, China
Lin-Lin Li, Department of Pathology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Author contributions: Wang HM, Yu AY and Li LL contributed equally to this work and are co-first authors; Wang HM and Yu AY contributed to the research design and paper writing; Li LL, Ma LY, Cao MH, Yang YL, Qin XB and Tang JJ collected and analyzed the data; Wang HM and Han ZX overall supervise the study; and all authors contributed to the article and approved the submitted version.
Supported by Jiangsu Provincial Health Commission’s 2020 High-Level Health Talents “Six Ones Project” Top-Notch Talent Research Project, No. LGY2020006; and 2021 Youth Medical Science Innovation Project of Xuzhou Health Commission, No. XWKYHT20210580.
Institutional review board statement: The study was reviewed and approved by The Affiliated Hospital of Xuzhou Medical University (Approval No. XYFY2022-KL321-01).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zheng-Xiang Han, MD, Professor, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou 221000, Jiangsu, China. cnhzxyq@163.com
Received: November 20, 2023
Peer-review started: November 20, 2023
First decision: December 5, 2023
Revised: December 20, 2023
Accepted: December 25, 2023
Article in press: December 25, 2023
Published online: January 19, 2024
Processing time: 60 Days and 4 Hours
Abstract
BACKGROUND

Occult breast cancer (OBC) has traditionally been considered to be a carcinoma of unknown primary origin with a favorable prognosis and can be treated as stage II-III breast cancer. Due to the small number of cases and limited clinical ex-perience, treatments vary greatly around the world and no standardized treat-ment has yet been established.

AIM

To investigate the clinicopathological features, psychological status and prog-nostic features of patients with OBC.

METHODS

The clinicopathological data of 33 OBC patients diagnosed and treated in the Affiliated Hospital of Xuzhou Medical University and Xuzhou Central Hospital from November 2015 to November 2022 were retrospectively analyzed. The psychological status of OBC patients was evaluated by the Self-rating Anxiety Scale and Self-rating Depression Scale. Patients’ emotions, stress perception and psychological resilience were evaluated by the Positive and Negative Affect Schedule, the Chinese Perceived Stress Scale, and the Connor-Davidson Resilience Scale (CD-RISC), respectively. Patient survival was calculated using the Kaplan-Meier method, and survival curves were plotted for analysis with the log-rank test. Univariate and multivariate survival analyses were performed using the Cox regression model.

RESULTS

The 33 OBC patients included 32 females and 1 male. Of the 33 patients, 30 (91%) had axillary tumors, 3 (9%) had a neck mass as the primary symptom; 18 (54.5%) had estrogen receptor-positive tumors, 17 (51.5%) had progesterone receptor-positive tumors, and 18 (54.5%) had Her-2-positive tumors; 24 (72.7%) received surgical treatment, including 18 patients who underwent modified radical mastectomy, 1 patient who underwent breast-conserving surgery plus axillary lymph node dissection (ALND), and 5 patients who underwent ALND alone; 12 patients received preoperative neoadjuvant therapy. All 30 patients developed anxiety and depression, with low positive affect scores and high negative affect scores, accompanied by a high stress level and poor psychological resilience. There were no differences in the psychological status of patients according to age, body mass index, or menopausal status. The overall survival and disease-free survival (DFS) of all the patients were 83.3% and 55.7%, respectively. Univariate analysis demonstrated that the initial tumor site (P = 0.021) and node stage (P = 0.020) were factors that may affect patient prognosis. The 5-year DFS rate of OBC patients who received radiotherapy was greater (P < 0.001), while the use of different surgical methods (P = 0.687) had no statistically significant effect on patient outcomes. Multivariate analysis revealed that radiotherapy (P = 0.031) was an independent prognostic factor. Receiving radiotherapy had a significant effect on the CD-RISC score (P = 0.02).

CONCLUSION

OBC is a rare breast disease whose diagnosis and treatment are currently controversial. There was no significant difference in the efficacy of other less invasive surgical procedures compared to those of modified radical mastectomy. In addition, radiotherapy can significantly improve patient outcomes. We should pay attention to the psychological state of patients while they receive antitumor therapy.

Keywords: Occult breast cancer; Breast cancer; Perceived Stress Scale; Axillary lymph node dissection

Core Tip: Occult breast cancer (OBC) has traditionally been considered to be a carcinoma of unknown primary origin with a favorable prognosis and can be treated as stage II-III breast cancer. This study aimed to investigate the clinicopathological features, psychological status and prognostic factors of patients with OBC. The authors found that radiotherapy can significantly improve patient outcomes. The psychological state of patients while they receive antitumor therapy should be paid more attention.