Muzaffar Mahvish, Kachare Swapnil, Vohra Nasreen
Division of Hematology Oncology, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC.
Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC.
Clin Breast Cancer. 2017 Jun;17(3):e143-e149. doi: 10.1016/j.clbc.2016.11.001. Epub 2016 Nov 22.
Primary tumor surgery (PTS) is not a standard treatment modality in stage IV breast cancer. Retrospective studies in female breast cancer show improved survival in women undergoing PTS; however, data regarding the impact of surgery in male breast cancer are lacking. The objective of this study was to analyze the impact of PTS on survival among men with metastatic breast cancer.
A retrospective study was conducted of men diagnosed with metastatic breast cancer at diagnosis were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2011. Cox proportional hazards regression models were used to compare the differences in survival in men who did and did not undergo PTS.
A total of 439 men with stage IV breast cancer at diagnosis were identified, of which 222 (51%) underwent PTS, 171 (77%) mastectomy, and 51 (23%) partial mastectomy. The median age was 65 years; 74% of participants were white, 51% had tumors ≤ T2, 65% had estrogen receptor (ER)-positive tumor, and 24% had unknown ER status. Univariate analysis between the surgery and no-surgery arms showed that white race (P = .04), lower T stage and grade (P = .0003, P = .004), ER positivity (P = .0002), and later year of diagnosis (P < .0001) were associated with better survival. PTS was associated with improvement in median overall survival (29 vs. 11 months, P < .0001). On Cox regression analysis, ER negativity (hazard ratio = 2.08; 95% confidence interval, 1.41-3.01; P < .0003) and not undergoing PTS were associated with diminished survival (hazard ratio = 1.81; 95% confidence interval, 1.42-2.31; P < .0001).
PTS among men with metastatic breast cancer was associated with improved survival in this retrospective analysis.
原发性肿瘤手术（PTS）并非IV期乳腺癌的标准治疗方式。针对女性乳腺癌的回顾性研究显示，接受PTS的女性生存率有所提高；然而，关于手术对男性乳腺癌影响的数据却很匮乏。本研究的目的是分析PTS对转移性乳腺癌男性患者生存率的影响。
对1988年至2011年监测、流行病学和最终结果（SEER）数据库中确诊为转移性乳腺癌的男性进行回顾性研究。采用Cox比例风险回归模型比较接受和未接受PTS的男性患者在生存率上的差异。
共识别出439例确诊时为IV期乳腺癌的男性患者，其中222例（51%）接受了PTS，171例（77%）接受了乳房切除术，51例（23%）接受了部分乳房切除术。中位年龄为65岁；74%的参与者为白人，51%的患者肿瘤≤T2，65%的患者雌激素受体（ER）阳性肿瘤，24%的患者ER状态未知。手术组与非手术组的单因素分析显示，白人种族（P = .04）、较低的T分期和分级（P = .0003，P = .004）、ER阳性（P = .0002）以及较晚的诊断年份（P < .0001）与更好的生存率相关。PTS与中位总生存期的改善相关（29个月对11个月，P < .0001）。在Cox回归分析中，ER阴性（风险比 = 2.08；95%置信区间，1.41 - 3.01；P < .0003）和未接受PTS与生存率降低相关（风险比 = 1.81；95%置信区间，1.42 - 2.31；P < .0001）。
在这项回顾性分析中，转移性乳腺癌男性患者接受PTS与生存率提高相关。
