Department of Radiation Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Radiation Oncology, M.M. Institute of Medical Sciences and Research, Ambala, Haryana, India.
J Cancer Res Ther. 2020 Oct-Dec;16(6):1287-1293. doi: 10.4103/jcrt.JCRT_1305_16.
Male breast cancer (MBC) incidence is <1%, but it is increasing. MBC incidence increases with age. There are no randomized trials on MBC because of low number of patients seen in any institution and hence its management is derived from breast cancer (BC) in women. In this study, we analyzed outcome in MBC patients with adjuvant treatment.
From 1991 to 2014, 81 men with BC were retrospectively analyzed for demographic, clinicopathological, and treatment outcomes. Disease-free survival (DFS) was defined as time duration from diagnosis to first recurrence. Overall survival (OS) was defined as time duration from pathologic diagnosis to death or last follow-up with any death defined as an event. DFS and OS were estimated using Kaplan-Meier method and compared between patients receiving and not receiving adjuvant treatment using log-rank test.
The median age was 57 years (range 30-86 years). Right, left, and bilateral BCs were seen in 41 (51%), 38 (47%), and 2 (2%) men, respectively. The mean duration of symptoms was 25 months (range 1-240 months). Comorbidity and family history was present in 31 (38%) and 3 (4%) men, respectively. The mean tumor size was 5 cm × 5 cm (range, 1 cm × 1 cm to 10 cm × 10 cm). Nipple was involved in 46 (57%) men. Early, locally advanced, and metastatic disease were seen in ??30 (37%), 34 (42%), and 17 (21%) men, respectively. Majority (71, 88%) of men had invasive ductal carcinoma histology. In radically treated 64 men, neoadjuvant chemotherapy was given to 12 (19%) patients (fluorouracil, adriamycin, and cyclophosphamide [FAC] to 9 and FAC + taxanes to 3), with CR in 4 (33.3%) and partial response (PR) in 8 (66.7%) patients. Mastectomy was done in 55 (86%) and wide local excision in 9 (14%) men. Margins and nodes were positive in 17 (27%) and 38 (59%) men, respectively. Estrogen receptor, PR, and human epidermal growth factor receptor 2/neu positive were seen in 27 (42%), 17 (26.5%), and 2 (3%) patients, respectively. Adjuvant hypofractionated radiotherapy, chemotherapy, and tamoxifen were received by 51 (80%), 35 (55%), and 45 (70%) men, respectively. Median follow-up was 60 months (range 4-278 months). Locoregional recurrence occurred in 8 (12.5%) and distant metastasis in 22 (34%) men, respectively. DFS and OS at 10 years were 42% and 53%, respectively. DFS and OS were significantly better in men with adjuvant radiation (54% vs. 24%, P = 0.007 and 57% vs. 35%, P = 0.022, respectively) and hormonal therapy (57% vs. 14.5%, P = 0.004 and 62% vs. 39%, P = 0.045, respectively). Chemotherapy had no impact on DFS and OS.
Adjuvant hypofractionated radiotherapy and hormonal therapy significantly improved DFS and OS in MBC patients. Chemotherapy had no impact on DFS and OS.
男性乳腺癌（MBC）的发病率<1%，但呈上升趋势。MBC 的发病率随年龄增长而增加。由于任何机构的患者数量都很少，因此没有关于 MBC 的随机试验，因此其治疗方法源自女性乳腺癌（BC）。在这项研究中，我们分析了接受辅助治疗的 MBC 患者的结果。
1991 年至 2014 年，回顾性分析了 81 例男性 BC 患者的人口统计学、临床病理和治疗结果。无病生存期（DFS）定义为从诊断到首次复发的时间间隔。总生存期（OS）定义为从病理诊断到死亡或最后随访的时间间隔，任何死亡均定义为事件。使用 Kaplan-Meier 法估计 DFS 和 OS，并使用对数秩检验比较接受和未接受辅助治疗的患者之间的差异。
中位年龄为 57 岁（范围 30-86 岁）。右侧、左侧和双侧 BC 分别见于 41（51%）、38（47%）和 2（2%）名男性。症状持续时间的平均值为 25 个月（范围 1-240 个月）。分别有 31（38%）和 3（4%）名男性有合并症和家族史。肿瘤大小的平均值为 5cm×5cm（范围，1cm×1cm 至 10cm×10cm）。乳头受累见于 46（57%）名男性。早期、局部晚期和转移性疾病分别见于??30（37%）、34（42%）和 17（21%）名男性。大多数（71，88%）男性为浸润性导管癌组织学。在接受根治性治疗的 64 名男性中，12 名（19%）患者接受了新辅助化疗（9 名患者接受氟尿嘧啶、阿霉素和环磷酰胺[FAC]，3 名患者接受 FAC+紫杉类药物），其中 4 名（33.3%）患者获得完全缓解，8 名（66.7%）患者获得部分缓解。55 名（86%）男性接受了乳房切除术，9 名（14%）男性接受了广泛局部切除术。17 名（27%）和 38 名（59%）男性的边缘和淋巴结阳性，分别为 17（27%）和 38（59%）。27（42%）、17（26.5%）和 2（3%）名患者的雌激素受体、孕激素受体和人表皮生长因子受体 2/neu 阳性，分别为 27（42%）、17（26.5%）和 2（3%）。分别有 51（80%）、35（55%）和 45（70%）名男性接受了辅助短程放疗、化疗和他莫昔芬治疗。中位随访时间为 60 个月（范围 4-278 个月）。局部区域复发发生在 8 名（12.5%）男性中，远处转移发生在 22 名（34%）男性中。10 年DFS 和 OS 分别为 42%和 53%。DFS 和 OS 在接受辅助放疗的男性中明显更好（54%比 24%，P=0.007；57%比 35%，P=0.022）和接受激素治疗的男性中（57%比 14.5%，P=0.004；62%比 39%，P=0.045）。化疗对 DFS 和 OS 没有影响。
MBC 患者接受辅助短程放疗和激素治疗可显著提高 DFS 和 OS。化疗对 DFS 和 OS 没有影响。
