Male breast cancer. Evolution of treatment and prognostic factors. Analysis of 489 cases☆

https://doi.org/10.1016/j.critrevonc.2009.04.002Get rights and content

Abstract

Background

Infiltrating MBC represents less than 1% of all male cancers. Our study details clinico-pathological features, treatments and prognostic factors in a large French cohort.

Material and methods

Four hundred and eighty-nine patients were collected from 1990 to 2005. Median age was 66 years (34% over 70 years) and median follow-up 58 months.

Results

According to TN classification, we found T1: 39%, T2: 41%, T3T4: 9%, Tx: 11% and N1N2: 27%. Lumpectomy (L) and mastectomy (M) were performed in 8.6% and 91.4% of the cases. Axillary dissection (AD), sentinel node biopsy or both were performed in 90%, 2% and 5% of the cases, respectively. Ninety-five percent of tumours were ductal carcinomas; 47% were pT1, 20% pT2 and 33% pT3–T4. Axillary nodal involvement was present in 52.8% cases. ER and PgR were positive in 92% and 89% cases. Radiotherapy (RT) was performed in 85% of the patients. Hormonal treatment (HT) was delivered in 72% of the cases. Tamoxifen and aromatase inhibitors were used in 85% and 12% of the cases; 34% of the patients received chemotherapy (CT).

Local recurrence (LR), nodal recurrences (NR) and metastases occurred in 2%, 5% and 22% of the cases; 2% and 10% developed contralateral BC and second cancer. The 5- and 10-year overall survival (OS) rates were 81% and 59%; disease-specific survivals (DSS) were 89% and 72%. Death causes were BC 56%, second cancer 8%, complications 3%, intercurrent disease 15% and unknown 18%. In a univariate analysis, metastatic risk factors were T stage (T1: 19%, T2: 26%, T3T4: 40%; p = 0.013), pN status (pN0: 12% pN1–3: 26% pN>3: 44%; p < 0.0001) and presence of locoregional recurrence (62% versus 18% p < 0.0001). In a multivariate analysis, axillary nodal involvement and high SBR remain prognostic factors.

Conclusion

Earlier diagnosis and wide use of adjuvant treatments (RT/HT/CT) widely decreased LR and increased survival rates in MBC, reaching female ones. Prognostic factors were also very similar to female ones.

Introduction

Male breast cancer (MBC) is a rare disease representing less than 1% of all malignancies in men and only 1% of all incident breast cancers (BC) in western countries [1], [2], [3], [4]. No randomized trials are available for this disease and less than ten retrospective studies including more than 200 cases have been reported [5], [6], [7], [8], [9], [10], [11].

This large co-operative study (489 cases) allowed us to assess histopathological features (e.g. axillary nodal involvement, hormone receptors status), locoregional and systemic treatment modalities, as well as clinical and histopathological prognostic factors.

Section snippets

Patients’ characteristics

From 1990 to 2005, 566 patients with MBC treated in eleven regional cancer centres, two private clinics and one university hospital were collected. Seventy-seven were excluded due to: metastasis at diagnosis (n = 24), previous or synchronous other cancer (n = 16), neoadjuvant treatment (n = 13), bilateral synchronous BC (n = 6) and pure in situ (DCIS) histology (n = 18). Hence, 489 cases were available for analysis. Median follow-up was 58 months.

Median age was 66 years (range: 24–94); 51 (10.5%)

Locoregional recurrences

Two patients out of 42 (5%) relapsed in the breast after conservative surgery and only 7 out of 433 (1.6%) after mastectomy. There are no significant predictive factors (e.g. tumours size/axillary nodal involvement/age) of local recurrence (LR).

Twenty-six (5.3%) patients had nodal relapse, 20 of whom in the axilla: 2 (12.5%) among 16 patients without axillary surgery, 23 (5.3%) among 436 patients who underwent AD (24 with previous SNB) and one (11%) among 9 patients who had SNB alone (p = NS).

Discussion

Our report confirms the high median age on the onset of the disease (66 years), such as in a large American series (67 years) [12]. Our axillary nodal involvement rate is similar to other reports [6], [13], [14], [15], [16], [17] and is significantly correlated to pT and SBR grading [5], [7]. In comparison with a recent national survey in women [18], the axillary nodal involvement rate in men is higher in pT1 (39% versus 34%), slightly less in pT2 (55% versus 60%) and identical (68%) in larger

Conclusion

Due to a better disease knowledge and optimal use of locoregional and systemic treatments, OS and DSS rates have recently become similar to women when compared at the same stage [63]. Whereas BC incidence seems to decline in women, several studies have shown a slight increase in men [64], [65], [66]. However, MBC occurs approximately 8–10 years later than FBC [2], [3], [11]; consequently, the impact of comorbidities and second neoplasm is more important and can induce confusion in comparative

Conflict of interest

There is no conflict of interest.

Acknowledgements

We are grateful to Natahlie HEIL and Diane PENET for their help in preparing this manuscript, and Pfizer for logistical support.

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    ☆

    Presented in part at the 30th Breast Cancer Symposium, San Antonio 12.12.07 and at the 6th European Breast Cancer Conference, Berlin 17.04.08.

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