Department of Radiation Oncology, University of California, San Francisco, CA.
Clin Breast Cancer. 2013 Oct;13(5):344-9. doi: 10.1016/j.clbc.2013.05.004. Epub 2013 Jul 26.
Male breast cancer (MBC) accounts for approximately 1% of all breast cancers. Given the rarity of this disease, treatment of MBC generally follows the same principles as treatment of female breast cancer. However, the traditional surgical approach for MBC is modified radical mastectomy (MRM) or total simple mastectomy (TSM) instead of breast conservation surgery (BCS). The purpose of this study was to examine the feasibility of BCS as an alternative to mastectomy for MBC with respect to musculoskeletal functionality and treatment outcome.
A retrospective analysis was undertaken of all male patients with breast cancer who presented to Massachusetts General Hospital or Boston Medical Center for localized therapy from 1990 to 2003. Musculoskeletal functionality (tissue fibrosis, arm edema, and range of motion) and treatment outcome (local-regional control, disease-free survival, and overall survival) were evaluated. Functional/cosmetic outcomes were assessed by multidisciplinary review of patient follow-up visits and were scored as either "good-excellent" or "fair-poor" to account for subjectivity between different clinicians.
Forty-two patients in total were identified to undergo localized treatment. Thirty patients (71%) received MRM, 4 (10%) had TSM, and 8 (19%) underwent BCS. Actuarial overall 1-year fair-poor documented tissue fibrosis, arm edema, and decreased range of motion rates were 13%, 23%, and 27% for patients receiving MRM; 25%, 0%, and 50% for patients who underwent TSM; and 13%, 0%, and 0% for those undergoing BCS, respectively. Overall survival and disease-free survival were not statistically different between the groups.
These data suggest that breast conservation therapy may be considered a reasonable local treatment option for male patients presenting with breast cancer because it may offer functional advantages over mastectomy with comparable rates of local control and disease-free survival and overall survival.
男性乳腺癌（MBC）约占所有乳腺癌的 1%。鉴于这种疾病的罕见性，MBC 的治疗通常遵循与女性乳腺癌相同的原则。然而，MBC 的传统手术方法是改良根治性乳房切除术（MRM）或单纯乳房切除术（TSM），而不是保乳手术（BCS）。本研究旨在探讨保乳手术替代 MBC 乳房切除术在肌肉骨骼功能和治疗结果方面的可行性。
对 1990 年至 2003 年期间在马萨诸塞州综合医院或波士顿医疗中心因局部治疗就诊的所有男性乳腺癌患者进行了回顾性分析。评估了肌肉骨骼功能（组织纤维化、手臂水肿和运动范围）和治疗结果（局部区域控制、无病生存率和总生存率）。功能/美容结果通过多学科评估患者随访情况进行评估，并根据不同临床医生之间的主观性评为“良好-优秀”或“一般-差”。
总共确定了 42 例接受局部治疗的患者。30 例（71%）患者接受了 MRM，4 例（10%）患者接受了 TSM，8 例（19%）患者接受了 BCS。接受 MRM 的患者 1 年总生存率较差的组织纤维化、手臂水肿和运动范围降低率分别为 13%、23%和 27%；接受 TSM 的患者分别为 25%、0%和 50%；接受 BCS 的患者分别为 13%、0%和 0%。各组之间的总生存率和无病生存率无统计学差异。
这些数据表明，保乳治疗可能被认为是男性乳腺癌患者的一种合理的局部治疗选择，因为它可能比乳房切除术具有更好的功能优势，并且具有可比的局部控制率、无病生存率和总生存率。
