Science for Life Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Dag Hammarskjoldsvag 20, 751 85, Uppsala, Sweden.
Department of Oncology, Uppsala University Hospital, 751 85, Uppsala, Sweden.
Breast Cancer Res Treat. 2024 Jan;203(2):235-243. doi: 10.1007/s10549-023-07129-1. Epub 2023 Oct 9.
Evidence supporting the use of neoadjuvant chemotherapy (NAC) in early breast cancer is based on studies mainly including women, whereas the utilization and effectiveness of NAC in men is less studied. The present study aimed to investigate the utilization and effectiveness of NAC in men and women with early breast cancer.
Eligible patients were identified through the Swedish National Breast Cancer Quality Register, that includes all newly diagnosed breast cancer cases in Sweden from 2008 and onwards. For the treatment utilization analysis, all patients with stage I-III between 2008 and 2020 were included (n = 82,888), whereas for the effectiveness analysis the cohort was restricted to patients receiving NAC (n = 6487). For both analyses, multivariate logistic regression models were applied to investigate potential sex disparities in NAC utilization and effectiveness, adjusted for patient- and tumor characteristics.
In the NAC utilization analysis, 487 men and 82,401 women with stage I-III were included. No statistically significant difference between sexes in terms of NAC utilization was observed (adjusted Odds Ratio (adjOR): 1.135; 95% Confidence Interval (CI) 0.606-2.128) with an overall utilization rate of 4.9% in men compared to 7.8% in women. Among the 24 men and 6463 women who received NAC, the pathologic complete response (pCR) rates were 16.7% and 21.2%, respectively (adjOR: 1.141; 95% CI 0.141-9.238).
The present study did not find any sex disparities in NAC utilization or effectiveness in terms of pCR. This supports the current recommendations of treating men with breast cancer with the same indications for NAC as women.
支持早期乳腺癌使用新辅助化疗（NAC）的证据主要基于包括女性在内的研究，而男性中 NAC 的使用和有效性研究较少。本研究旨在调查早期乳腺癌男性和女性中 NAC 的使用和有效性。
通过瑞典国家乳腺癌质量登记处确定符合条件的患者，该登记处包括 2008 年以来瑞典所有新诊断的乳腺癌病例。为了进行治疗利用分析，纳入了 2008 年至 2020 年间所有 I-III 期患者（n=82888），而在有效性分析中，队列仅限于接受 NAC 的患者（n=6487）。对于这两项分析，应用多变量逻辑回归模型调查了 NAC 利用和有效性方面潜在的性别差异，并根据患者和肿瘤特征进行了调整。
在 NAC 利用分析中，纳入了 487 名男性和 82401 名女性 I-III 期患者。在 NAC 利用方面，男性和女性之间没有统计学显著差异（调整后的优势比（adjOR）：1.135；95%置信区间（CI）：0.606-2.128），男性的总体利用率为 4.9%，而女性为 7.8%。在接受 NAC 的 24 名男性和 6463 名女性中，病理完全缓解（pCR）率分别为 16.7%和 21.2%（adjOR：1.141；95%CI：0.141-9.238）。
本研究未发现 NAC 利用或 pCR 有效性方面的任何性别差异。这支持了目前关于用 NAC 治疗乳腺癌男性的建议，与女性相同的适应证。
