Outcomes of Partial Mastectomy in Male Breast Cancer Patients: Analysis of SEER, 1983-2009
Outcomes of Partial Mastectomy in Male Breast Cancer Patients: Analysis of SEER, 1983-2009
复制标题
DOI：
10.1245/s10434-013-2918-5
复制
发表时间：
2013-05-01
影响因子：
3.7
通讯作者：
Wapnir, Irene L.
中科院分区：
文献类型：
--
作者：
Cloyd, Jordan M.;Hernandez-Boussard, Tina;Wapnir, Irene L.
虽然乳房切除术被认为是男性乳腺癌的金标准，但肿块切除术的应用及其对男性乳腺癌患者预后的影响尚未被研究过。1983年至2009年期间，使用监测、流行病学和最终结果(SEER)数据库来确定所有接受过乳房切除术或少于乳房切除术(即肿块切除术)的MBC患者。共有4707名男性(86.8%)接受了乳房切除术，718名(13.2%)接受了肿块切除术。在研究期间后期接受肿块切除术的患者比例更高(1983至1986年，10.6%；2007至2009年，15.1%)。80岁或以上(21.3%比16.3%)，有IV期疾病(7.3%比3.1%)，没有接受淋巴结采样(34.3%比6.9%)的肿瘤切除患者所占比例更大。仅35.4%的患者在肿瘤切除后接受了辅助放射治疗。肿块切除患者的10年乳腺癌特定存活率和总存活率分别为82.8%和46.9%，而乳房切除患者分别为77.3%和46.4%。在COX比例风险回归分析中，在控制了年龄、种族、分期和分级以及是否接受放射治疗后，肿块切除术与乳腺癌的特殊生存率(优势比1.09，95%可信区间0.87-1.37)或总体生存率(优势比1.12，95%可信区间0.98-1.27)无关。这些患者不仅年龄较大，在确诊时更有可能患有晚期疾病，而且他们也不太可能接受标准的护理治疗，如淋巴结采样和辅助放射治疗。尽管有这些观察，乳腺癌患者的存活率不受手术类型的影响。
Although mastectomy is considered the gold standard for male breast cancer (MBC), the utilization of lumpectomy and its impact on outcomes in MBC patients has not been previously studied.The Surveillance, Epidemiology and End Results (SEER) database was used to identify all MBC patients who underwent either mastectomy or less than mastectomy (i.e., lumpectomy) between 1983 and 2009.A total of 4707 (86.8 %) men underwent mastectomy and 718 (13.2 %) underwent lumpectomy. A greater proportion of patients underwent lumpectomy later in the study period (1983 to 1986, 10.6 %, vs. 2007 to 2009, 15.1 %). A greater percentage of lumpectomy patients were 80 years or older (21.3 % vs. 16.3 %), had stage IV disease (7.3 % vs. 3.1 %), and received no lymph node sampling (34.3 % vs. 6.9 %). Only 35.4 % of patients underwent adjuvant radiotherapy after lumpectomy. Ten-year breast cancer-specific survival and overall survival were 82.8 % and 46.9 %, respectively, in lumpectomy patients vs. 77.3 % and 46.4 %, respectively, in mastectomy patients. On Cox proportional hazards regression, lumpectomy was not independently associated with worse breast cancer-specific survival (odds ratio 1.09, 95 % confidence interval 0.87-1.37) or overall survival (odds ratio 1.12, 95 % confidence interval 0.98-1.27) after controlling for age, race, stage, and grade, as well as whether radiotherapy was received.Lumpectomy is performed in a small but growing proportion of MBC patients. These patients are not only older and more likely to have advanced disease at the time of diagnosis, but they also are less likely to receive standard of care therapy, such as lymph node sampling and adjuvant radiotherapy. Despite these observations, breast cancer-specific survival is unaffected by the type of surgery.