PennState Milton S. Hershey Medical Center, General Surgery, Hershey, Pennsylvania.
Penn State College of Medicine, Hershey, Pennsylvania.
J Surg Res. 2024 Jan;293:685-692. doi: 10.1016/j.jss.2023.08.053. Epub 2023 Oct 13.
Occult breast cancer (OBC) consists of <0.1% of breast cancer cases in the United States. Male occult breast cancer (mOBC) has not been well-studied outside of case reports, and management is largely based on female OBC (fOBC) studies. We aim to examine the prevalence of mOBC among those in the National Cancer Database with breast cancer and describe treatment modalities received by mOBC compared to fOBC.
The National Cancer Database was queried for patients with OBC from 2004 to 2018. Chi-Square test and Fisher's exact tests compared patient, clinical, and facility characteristics by sex. Treatment modalities [systemic therapy, radiation therapy, axillary lymph node dissection, modified radical mastectomy (MRM)] were compared. A subgroup analysis examined pathologic upstaging in patients who underwent MRM.
Of 23,374 male patients with breast cancer, 0.13% were identified to have mOBC [versus 0.09% in fOBC]. cN2/N3 disease was significantly more prevalent in the mOBC cohort (61.3%) than in the fOBC cohort (30.7%, P < 0.001). Receipt of axillary lymph node dissection or MRM was not significantly different by sex. Male OBC (mOBC) patients were less likely to receive trimodality treatment than fOBC patients. In patients who underwent MRM, more mOBC patients [75%] were pathologically upstaged as T+ after mastectomy than fOBC patients [30%, P < 0.001], questioning the adequacy of diagnostic workup for mOBC compared to fOBC.
This review confirms mOBC as an extremely rare disease. Multimodal treatments have been highly utilized to optimize care in this patient population. Further investigation is warranted to examine the survival benefit of treatment regimens for mOBC.
隐匿性乳腺癌（OBC）占美国乳腺癌病例的<0.1%。除病例报告外，男性隐匿性乳腺癌（mOBC）研究甚少，其治疗方法主要基于女性隐匿性乳腺癌（fOBC）的研究。我们旨在检查美国国家癌症数据库中患有乳腺癌的患者中 mOBC 的患病率，并描述 mOBC 与 fOBC 相比所接受的治疗方式。
从 2004 年至 2018 年，我们在国家癌症数据库中查询了 OBC 患者。通过性别比较患者、临床和医疗机构特征的卡方检验和 Fisher 精确检验。比较治疗方式[系统治疗、放射治疗、腋窝淋巴结清扫术、改良根治性乳房切除术（MRM）]。亚组分析检查了接受 MRM 的患者的病理升级情况。
在 23374 名患有乳腺癌的男性患者中，有 0.13%被确定患有 mOBC[而 fOBC 为 0.09%]。cN2/N3 期疾病在 mOBC 组（61.3%）比 fOBC 组（30.7%）更为常见（P<0.001）。接受腋窝淋巴结清扫术或 MRM 的患者性别之间无显著差异。与 fOBC 患者相比，mOBC 患者接受三联治疗的可能性较小。在接受 MRM 的患者中，mOBC 患者术后病理升级为 T+的比例（75%）高于 fOBC 患者（30%）（P<0.001），这表明与 fOBC 相比，mOBC 的诊断性检查不够充分。
本综述证实 mOBC 是一种极为罕见的疾病。多模式治疗已广泛应用于优化该患者群体的治疗。需要进一步研究来检查 mOBC 治疗方案的生存获益。
