Comprehensive Breast Program, Department of Women's Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida 33612, USA.
Breast J. 2011 Sep-Oct;17(5):503-9. doi: 10.1111/j.1524-4741.2011.01148.x. Epub 2011 Aug 29.
National Comprehensive Cancer Network (NCCN) guidelines for female breast cancer treatment and surveillance are well established, but similar guidelines on male breast cancers are less recognized. As an NCCN institution, our objective was to examine practice patterns and follow-up for male breast cancer compared to established guidelines for female patients. After Institutional Review Board approval, a prospective breast database from 1990 to 2009 was queried for male patients. Medical records were examined for clinico-pathological factors and follow-up. The 5-year survival rates with 95% confidence intervals were estimated using Kaplan-Meier method and Greenwood formula. Of the 19,084 patients in the database, 73 (0.4%) were male patients; 62 had complete data. One patient had bilateral synchronous breast cancer. The median age was 68.8 years (range 29-85 years). The mean/median invasive tumor size was 2.2/1.6 cm (range 0.0-10.0 cm). All cases had mastectomy (29 with axillary node dissection, 23 with sentinel lymph node biopsy only, 11 with sentinel node biopsy followed by completion axillary dissection). Lymph node involvement occurred in 25/63 (39.7%). Based on NCCN guidelines, chemotherapy, hormonal therapy, and radiation are indicated in 34 cases, 62 cases, and 14 cases, respectively. Only 20/34 (59%) received chemotherapy, 51/62 (82%) received hormonal therapy, and 10/14 (71%) received post-mastectomy radiation. Median follow-up was 26.2 months (range: 1.6-230.9 months). The 5-year survival estimates for node positive and negative diseases were 68.5% and 87.5%, respectively (p = 0.3). Despite the rarity of male breast cancer, treatment options based on current female breast tumors produce comparable results to female breast cancer. Increased awareness and a national registry for patients could help improve outcomes and tailor treatment recommendations to the male variant.
美国国家综合癌症网络（NCCN）制定的女性乳腺癌治疗和监测指南已经得到广泛认可，但针对男性乳腺癌的类似指南则较少被认知。作为 NCCN 机构，我们的目标是检查男性乳腺癌的治疗方案和随访情况，以与女性患者的既定指南进行比较。在获得机构审查委员会批准后，我们对 1990 年至 2009 年的前瞻性乳腺数据库进行了查询，以寻找男性患者。我们对病历进行了检查，以了解临床病理因素和随访情况。使用 Kaplan-Meier 方法和 Greenwood 公式估计了 5 年生存率和 95%置信区间。在数据库的 19084 名患者中，有 73 名（0.4%）为男性患者；其中 62 名患者的资料完整。1 名患者患有双侧同时性乳腺癌。中位年龄为 68.8 岁（范围 29-85 岁）。平均/中位浸润性肿瘤大小为 2.2/1.6cm（范围 0.0-10.0cm）。所有患者均接受了乳房切除术（29 例接受腋窝淋巴结清扫术，23 例仅接受前哨淋巴结活检，11 例接受前哨淋巴结活检后行腋窝清扫术）。25/63（39.7%）例患者存在淋巴结受累。根据 NCCN 指南，34 例、62 例和 14 例患者分别需要接受化疗、激素治疗和放疗。仅有 20/34（59%）例患者接受了化疗，51/62（82%）例患者接受了激素治疗，10/14（71%）例患者接受了乳房切除术后放疗。中位随访时间为 26.2 个月（范围：1.6-230.9 个月）。淋巴结阳性和阴性疾病的 5 年生存率估计分别为 68.5%和 87.5%（p=0.3）。尽管男性乳腺癌较为罕见，但基于当前女性乳腺癌肿瘤的治疗方案可产生与女性乳腺癌相似的结果。提高对这种疾病的认识并建立全国性的患者登记系统，有助于改善预后，并根据男性乳腺癌的特点制定治疗建议。
