Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, USA.
Division of Hematology and Oncology, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA, USA.
Ann Surg Oncol. 2019 Jul;26(7):2144-2153. doi: 10.1245/s10434-019-07159-4. Epub 2019 Feb 13.
Current treatment guidelines for male breast cancer are predominantly guided by female-only clinical trials. With scarce research, it is unclear whether breast-conserving therapy (BCT) is equivalent to mastectomy in men. We sought to compare overall survival (OS) among male breast cancer patients who underwent BCT versus mastectomy.
We performed a retrospective analysis of 8445 stage I-II (T1-2 N0-1 M0) male breast cancer patients from the National Cancer Database (2004-2014). Patients were grouped according to surgical and radiation therapy (RT). BCT was defined as partial mastectomy followed by RT. Multivariable and inverse probability of treatment-weighted (IPTW) Cox proportional hazards models were used to compare OS between treatment groups, controlling for demographic and clinicopathologic characteristics.
Most patients underwent total mastectomy (61.2%), whereas 18.2% underwent BCT, 12.4% underwent total mastectomy with RT, and 8.2% underwent partial mastectomy alone. In multivariable and IPTW models, partial mastectomy alone, total mastectomy alone, and total mastectomy with RT were associated with worse OS compared with BCT (p < 0.001 all). Ten-year OS was 73.8% for BCT and 56.3, 58.0 and 56.3% for other treatment approaches. Older age, higher T/N stage, histological grade, and triple-negative receptor status were associated with poorer OS (p < 0.05). Subgroup analysis by stage demonstrated similar results.
In this national sample of male breast cancer patients, BCT was associated with greater survival. The underlying mechanisms of this association warrant further study, because more routine adoption of BCT in male breast cancer appears to translate into clinically meaningful improvements in survival.
目前男性乳腺癌的治疗指南主要基于仅针对女性的临床试验。由于研究较少，尚不清楚保乳治疗（BCT）是否与男性的乳房切除术相当。我们旨在比较接受 BCT 与乳房切除术的男性乳腺癌患者的总生存率（OS）。
我们对来自国家癌症数据库（2004-2014 年）的 8445 例 I 期- II 期（T1-2 N0-1 M0）男性乳腺癌患者进行了回顾性分析。患者根据手术和放疗（RT）进行分组。BCT 定义为部分乳房切除术加 RT。采用多变量和逆概率治疗加权（IPTW）Cox 比例风险模型比较治疗组之间的 OS，控制人口统计学和临床病理特征。
大多数患者接受了全乳房切除术（61.2%），而 18.2%接受了 BCT，12.4%接受了全乳房切除术加 RT，8.2%接受了单纯部分乳房切除术。在多变量和 IPTW 模型中，单独部分乳房切除术、单独全乳房切除术和全乳房切除术加 RT 与 BCT 相比，OS 更差（p<0.001 均）。BCT 的 10 年 OS 为 73.8%，而其他治疗方法分别为 56.3%、58.0%和 56.3%。年龄较大、T/N 分期较高、组织学分级和三阴性受体状态与较差的 OS 相关（p<0.05）。分期的亚组分析显示出相似的结果。
在这项针对男性乳腺癌患者的全国性样本研究中，BCT 与生存率的提高相关。这种关联的潜在机制值得进一步研究，因为在男性乳腺癌中更常规地采用 BCT 似乎转化为具有临床意义的生存改善。
