Den Jennifer, Nelson Nicole, Khanipov Kamil, Klimberg V Suzanne
From the Departments of Surgery (Den, Nelson, Klimberg), The University of Texas Medical Branch at Galveston, Galveston, TX.
Pharmacology and Toxicology (Khanipov), The University of Texas Medical Branch at Galveston, Galveston, TX.
J Am Coll Surg. 2025 Apr 1;240(4):627-635. doi: 10.1097/XCS.0000000000001285. Epub 2025 Mar 17.
Male breast cancer (MBC) is a rare disease, accounting for 1% of all breast cancer diagnosed in the US. The rarity of MBC has limited the development of treatment algorithms specific to men. Therefore, the standard of care has been mastectomy. The safety and feasibility of breast-conserving surgery (BCS) in MBC are unclear. This study assessed whether overall survival (OS) outcomes, local recurrence (LR), and postoperative complications differed between patients with MBC who underwent conservative surgery or mastectomy.
A retrospective search for men aged 18 years or older diagnosed with breast cancer was conducted using the TriNetX network. Cohort 1 included patients who underwent BCS. Cohort 2 included patients who underwent mastectomy. Propensity score matching was conducted using age, BMI, tobacco use, cancer stage and tumor size (T1 to T4), radiation, chemotherapy, hormonal therapy, genetics, and comorbidities. Outcomes of interest were 5-year OS, LR, and postoperative complications.
A total of 423 patients underwent BCS, and 1,101 patients underwent mastectomy. After matching, 401 patients per cohort were identified. No difference was observed in 5-year OS with the Kaplan-Meier analysis (Cohort 1: 84% vs Cohort 2: 86%, log-rank test p = 0.412) or with LR (11% vs 13%, p = 0.384). The mastectomy cohort was more likely to have postoperative complications, with a risk of 24% compared with 17% in the BCS cohort (p = 0.011).
No difference was observed in the 5-year OS and LR rate between patients with MBC who undergo BCS or mastectomy. The postoperative complication rate was higher with mastectomies. We conclude that BCS for unicentric MBC is feasible and preferred for T1 and T2 cancers.
男性乳腺癌（MBC）是一种罕见疾病，占美国所有确诊乳腺癌病例的1%。MBC的罕见性限制了针对男性的治疗方案的发展。因此，护理标准一直是乳房切除术。MBC保乳手术（BCS）的安全性和可行性尚不清楚。本研究评估了接受保守手术或乳房切除术的MBC患者的总生存期（OS）、局部复发（LR）和术后并发症是否存在差异。
使用TriNetX网络对18岁及以上诊断为乳腺癌的男性进行回顾性检索。队列1包括接受BCS的患者。队列2包括接受乳房切除术的患者。使用年龄、体重指数、吸烟情况、癌症分期和肿瘤大小（T1至T4）、放疗、化疗、激素治疗、遗传学和合并症进行倾向评分匹配。感兴趣的结果是5年总生存期、局部复发和术后并发症。
共有423例患者接受了BCS，1101例患者接受了乳房切除术。匹配后，每个队列确定了401例患者。通过Kaplan-Meier分析，5年总生存期无差异（队列1：84% vs队列2：86%，对数秩检验p = 0.412），局部复发也无差异（11% vs 13%，p = 0.384）。乳房切除队列术后并发症的发生率更高，风险为24%，而BCS队列中为17%（p = 0.011）。
接受BCS或乳房切除术的MBC患者在5年总生存期和局部复发率方面没有差异。乳房切除术的术后并发症发生率更高。我们得出结论，单中心MBC的BCS是可行的，对于T1和T2期癌症是首选。
