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男性三阴性乳腺癌的特征:一项基于人群的研究。

Characteristics of male triple negative breast cancer: A population-based study.

机构信息

Division of Hematology/Oncology, St. Louis University Hospital, St. Louis, Missouri, USA.

Division of Public Health Sciences, Alvin J. Siteman Cancer Center Biostatistics Core, Washington University School of Medicine, St. Louis, Missouri, USA.

出版信息

Breast J. 2020 Sep;26(9):1748-1755. doi: 10.1111/tbj.14023. Epub 2020 Aug 27.

Abstract

Male triple negative breast cancer (TNBC), which lacks expression of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), is a very rare entity, comprising only a very small percentage of all male breast cancer cases. Management strategies are typically based off research conducted in female TNBC patients; however, there is still much that remains unknown in the male cohort, such as risk factors for developing these malignancies, the optimal treatment approach, and both short-term and long-term outcome data. In this retrospective cohort study, we aimed to address these concerns by assessing both the characteristics of male patients who develop TNBC as well as their outcomes. We harnessed data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program and identified 66 male patients diagnosed with TNBC between 2010 and 2016. Patients were stratified by several variables including age, insurance status, time period of diagnosis, histology, nodal status, tumor grade, tumor stage at diagnosis, and treatment strategy employed for the assessment of overall survival (OS) differences. Our analysis demonstrated that stage remains the most important prognostic factor for OS, with higher stage corresponding to worse OS. A significant OS benefit was also identified in men undergoing a total mastectomy, compared to partial mastectomy or no surgery at all. We also identified that male patients are more likely to present with more advanced disease stages compared to their female counterparts and, therefore, have worse outcomes on average. This may be due to various factors, including the rarity of male TNBC cases and less clear screening guidelines for male breast cancer in general. Trends toward poorer OS with higher tumor grade, higher tumor T stage, advanced age, earlier time period of diagnosis, and ductal histology were also identified, but did not achieve statistical significance. The remaining variables did not appear to influence outcomes in a meaningful manner. In summary, our study suggests, similar to population studies of women with TNBC, that tumor stage is a major prognostic factor of OS in men with TNBC. The data also suggest that the surgical treatment strategy employed is also likely of significance, with improved OS being seen with total mastectomies over partial mastectomies. Other variables such as tumor grade and T stage also likely play a role, but did not achieve statistical significance owing to the small population size. Owing to the rarity of cases, further studies of male TNBC are needed to better understand this rare entity and guide future management strategies.

摘要

男性三阴性乳腺癌(TNBC)缺乏雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体 2(HER2)的表达,是一种非常罕见的实体,仅占所有男性乳腺癌病例的一小部分。管理策略通常基于在女性 TNBC 患者中进行的研究;然而,在男性队列中仍有许多未知因素,例如发展这些恶性肿瘤的风险因素、最佳治疗方法以及短期和长期预后数据。在这项回顾性队列研究中,我们旨在通过评估发生 TNBC 的男性患者的特征及其结局来解决这些问题。我们利用美国国家癌症研究所监测、流行病学和最终结果(SEER)计划的数据,确定了 2010 年至 2016 年间诊断为 TNBC 的 66 名男性患者。患者按年龄、保险状况、诊断时间、组织学、淋巴结状态、肿瘤分级、诊断时的肿瘤分期和治疗策略等几个变量分层,以评估总体生存率(OS)差异。我们的分析表明,分期仍然是 OS 的最重要预后因素,分期越高,OS 越差。与部分乳房切除术或根本不手术相比,接受全乳房切除术的男性患者也具有显著的 OS 获益。我们还发现,与女性相比,男性患者更有可能出现晚期疾病阶段,因此平均预后较差。这可能是由于各种因素造成的,包括男性 TNBC 病例的罕见性以及一般男性乳腺癌筛查指南不太明确。还发现肿瘤分级较高、肿瘤 T 分期较高、年龄较大、诊断时间较早和导管组织学与较差的 OS 趋势相关,但未达到统计学意义。其余变量似乎没有以有意义的方式影响结局。总之,我们的研究表明,与女性 TNBC 的人群研究相似,肿瘤分期是男性 TNBC 患者 OS 的主要预后因素。数据还表明,所采用的手术治疗策略也可能具有重要意义,全乳房切除术比部分乳房切除术的 OS 更好。其他变量,如肿瘤分级和 T 分期,也可能起作用,但由于人口规模较小,未达到统计学意义。由于病例罕见,需要进一步研究男性 TNBC,以更好地了解这种罕见实体并指导未来的管理策略。

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