Male breast cancer: Results of the treatments and prognostic factors in 397 cases
Male breast cancer: Results of the treatments and prognostic factors in 397 cases
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DOI：
10.1016/0959-8049(95)00366-5
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发表时间：
1995-11-01
影响因子：
8.4
通讯作者：
Berlie, J
中科院分区：
文献类型：
--
作者：
Cutuli, B;Lacroze, M;Berlie, J
本文回顾了1960~1986年在法国14个区域癌症中心治疗的397例非转移性男性乳腺癌(MBC)。年龄中位数为(25~93岁)。T0期7例，T1期79例，T2期162例，T3期31例，T4期74例，未分类瘤44例。31%的患者有临床阳性淋巴结。24例仅接受放射治疗，373例接受手术，其中247例接受术后放疗。采用辅助化疗71例，激素治疗68例。浸润性癌382例，单纯导管原位癌15例。56%的浸润性癌有淋巴结转移。雌激素受体(ER)和孕激素受体(PGR)阳性率分别为79%和77%。孤立的局部和区域复发率分别为8.8%和4.5%，40%的患者发生转移。Kaplan-Meier法5年和10年的粗生存率分别为65%和38%，疾病特异性生存率(无并发疾病和第二癌死亡)5年为74%，10年为51%。10年后，PN-和PN+组的疾病特异性存活率分别为77%和39%。影响预后的因素有临床大小(T)和腋窝组织状态(PN-/PN+)。T0-T1组、T2组和T3-T4组PN-死亡的相对危险度分别为1.0、2.0和3.2。对于PN+，这些相对危险度在同一组中分别增加了1.9、3.9和6.0。对于有局部复发危险因素(结节侵犯、大肿瘤累及皮肤或肌肉)的病例，最佳治疗方法为改良根治术和放射治疗。局部区域衰竭预后不良。一线辅助治疗似乎是他莫昔芬，因为激素受体阳性率很高，而且患者年龄较大，这在许多情况下禁止化疗。比较不同疾病的生存率、肿瘤大小和腋窝受累情况，乳腺癌患者的预后在男女患者中是相同的。
From 1960 to 1986, 397 cases of non-metastatic male breast cancer (MBC) treated in 14 French regional cancer centres were reviewed. The median age was 64 years (range 25-93). TNM classification (UICC, 1978) showed seven T0, 79 T1, 162 T2, 31 T3, 74 T4 and 44 unclassified tumours (Tx). Clinical positive lymph nodes were found in 31% of the patients. 24 patients received radiotherapy only, and 373 underwent surgery, 247 of these with postoperative irradiation. Adjuvant chemotherapy and hormonal therapy were used in 71 and 68 patients, respectively. There were 382 infiltrating carcinomas and 15 pure ductal carcinoma in situ. Lymph node involvement was found in 56% of infiltrating carcinoma. The oestregen (ER) and progesterone (PgR) receptors were positive in 79% and 77%, respectively, of examined cases. Isolated local and regional recurrence were observed in 8.8% and 4.5% of cases, respectively and 40% of patients developed metastases. The crude survival rates by Kaplan-Meier method were 65% and 38% at 5 and 10 years, respectively, and the disease-specific survival rates (without death due to intercurrent disease or second cancer) was 74% at 5 years and 51% at 10 years. The disease-specific survival rate for pN- and pN+ groups were 77% and 39% at 10 years. The prognostic factors were clinical size (T) and histological axillary status (pN-/pN+). The relative risk of death for pN- was 1.0, 2.0 and 3.2 in the T0-T1, T2 and T3-T4 groups, respectively. For pN+, these relative risks increased 1.9, 3.9 and 6.0 in the same groups. The optimal treatment include modified radical mastectomy and irradiation for cases with risk factors of local relapse (nodal invasion, large tumour with cutaneous or muscular involvement). Locoregional failure had unfavourable prognosis. First-line adjuvant treatment seems to be tamoxifen, due to the very high rate of positive hormonal receptors and the old age of the patients, which contraindicate chemotherapy in many cases. The prognosis of patients with breast cancer is the same in male and female patients when disease-specific survival rate, tumour size and axillary involvement ate compared.