Prognosis and therapeutic choices for occult breast cancer in female patients: a systematic review and meta-analysis.
- 1Department of Breast Surgical Oncology, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
- 2Department of Breast Disease, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
- 3Department of Breast Surgical Oncology, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China. [email protected].
Abstract
Background
Occult breast cancer (OBC) is a rare subtype characterized by axillary lymph node (LN) metastasis without an identifiable primary breast lesion. Owing to its rarity, optimal management remains controversial. We performed a systematic review and meta-analysis to comprehensively evaluate the clinicopathological characteristics, prognosis, and treatment outcomes of female patients with OBC.Methods
A systematic review and meta-analysis were conducted using PubMed/MEDLINE, Embase, and the Cochrane Library to identify eligible studies published after 2000. Female patients with OBC (T0N+M0) were included. Primary outcomes were overall survival (OS) and disease-free survival (DFS), analyzed according to LN stage and treatment strategies.Results
Thirty retrospective studies involving 6,001 patients were included. The pooled treatment proportions were 30% for mastectomy plus axillary lymph node dissection (ALND), 42% for ALND alone, and 68% for radiotherapy (RT). The pooled proportions of N1, N2, and N3 disease were 62%, 20%, and 12%, respectively. The pooled 5-year and 8-year OS rates were 90% and 64%. Compared with N1 disease, patients with N2-3 disease had significantly worse OS (HR 6.10, 95% CI 2.19-16.95). Mastectomy was not significantly associated with OS or DFS. RT was associated with improved OS (HR 0.60), whereas no significant association with DFS was observed.Conclusions
Female patients with OBC appear to have relatively favorable survival outcomes, while axillary nodal stage remains an important prognostic factor. Mastectomy was not associated with a clear survival advantage. RT appeared to be associated with improved OS; however, this finding should be interpreted cautiously because the available evidence was derived primarily from retrospective observational studies, and its effect on DFS remains uncertain. Further prospective studies are warranted to optimize treatment strategies for OBC.Trial registration prospero
CRD42024535815.
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BibTeX
@article{zhao2026prognosis,
title = {{Prognosis and therapeutic choices for occult breast cancer in female patients: a systematic review and meta-analysis.}},
author = {Zijun Zhao and Qingyao Shang and Chenxuan Yang and Jiaxiang Liu and Jiabin Wang and Xiyu Kang and Jiaxian Yue and Xin Wang and Xiang Wang},
journal = {BMC surgery},
year = {2026},
month = aug,
doi = {10.1186/s12893-026-04081-x},
url = {https://europepmc.org/article/MED/42958221},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Prognosis and therapeutic choices for occult breast cancer in female patients: a systematic review and meta-analysis.
AU - Zijun Zhao
AU - Qingyao Shang
AU - Chenxuan Yang
AU - Jiaxiang Liu
AU - Jiabin Wang
AU - Xiyu Kang
AU - Jiaxian Yue
AU - Xin Wang
AU - Xiang Wang
PY - 2026
DA - 2026/08/03
JO - BMC surgery
DO - 10.1186/s12893-026-04081-x
UR - https://europepmc.org/article/MED/42958221
AB - Background Occult breast cancer (OBC) is a rare subtype characterized by axillary lymph node (LN) metastasis without an identifiable primary breast lesion. Owing to its rarity, optimal management remains controversial. We performed a systematic review and meta-analysis to comprehensively evaluate the clinicopathological characteristics, prognosis, and treatment outcomes of female patients with OBC.Methods A systematic review and meta-analysis were conducted using PubMed/MEDLINE, Embase, and the Cochrane Library to identify eligible studies published after 2000. Female patients with OBC (T0N+M0) were included. Primary outcomes were overall survival (OS) and disease-free survival (DFS), analyzed according to LN stage and treatment strategies.Results Thirty retrospective studies involving 6,001 patients were included. The pooled treatment proportions were 30% for mastectomy plus axillary lymph node dissection (ALND), 42% for ALND alone, and 68% for radiotherapy (RT). The pooled proportions of N1, N2, and N3 disease were 62%, 20%, and 12%, respectively. The pooled 5-year and 8-year OS rates were 90% and 64%. Compared with N1 disease, patients with N2-3 disease had significantly worse OS (HR 6.10, 95% CI 2.19-16.95). Mastectomy was not significantly associated with OS or DFS. RT was associated with improved OS (HR 0.60), whereas no significant association with DFS was observed.Conclusions Female patients with OBC appear to have relatively favorable survival outcomes, while axillary nodal stage remains an important prognostic factor. Mastectomy was not associated with a clear survival advantage. RT appeared to be associated with improved OS; however, this finding should be interpreted cautiously because the available evidence was derived primarily from retrospective observational studies, and its effect on DFS remains uncertain. Further prospective studies are warranted to optimize treatment strategies for OBC.Trial registration prospero CRD42024535815.
SN - 1471-2482
ER -