Patterns of recurrence and treatment in male breast cancer: A clue to prognosis?
Patterns of recurrence and treatment in male breast cancer: A clue to prognosis?
复制标题
DOI：
10.1002/ijc.30225
复制
发表时间：
2016-10-15
影响因子：
6.4
通讯作者：
Lopes, Carlos
中科院分区：
文献类型：
--
作者：
Abreu, Miguel Henriques;Abreu, Pedro Henriques;Lopes, Carlos
男性乳腺癌（MBC）患者的生存率似乎低于女性（FBC）患者，通常的预后因素不能完全解释这一点。复发分析可以显示复发模式和/或患者方法的差异，以证明这些结果。回顾性分析1990年至2014年期间在癌症中心接受治疗的MBC患者，寻找复发。对于每例患者，根据诊断年份、年龄（5岁以内）、分期和肿瘤类型（仅考虑管腔样）选择3例匹配的FBC患者。通过卡方检验评估队列之间的差异，并进行分层聚类以根据复发局部定义亚组。采用Kaplan-Meier法计算生存曲线，并采用对数秩检验进行比较。统计学显著性定义为p < 0.05。根据年龄、组织学分级、分期、激素受体表达和辅助治疗平衡各组。至复发的中位时间相当，p = 0.72，大多数患者出现远处转移，p = 0.69，男性肺部受累更多，p =0.003。男性患者更常接受对症治疗（21.1% vs. 4.4%，p = 0.02）。男性的总体生存率和复发生存率较差，中位数：5年[95%置信区间（CI）：4.1-5.9年]和1年（95% CI：0-2.1年）vs. 10年（95% CI：7.8-12.2年）和2年（95%CI：1.6-2.4年），分别为p < 0.001和p = 0.004，并且这种趋势在五个聚类亚组中保持，这五个聚类亚组确定了五种复发模式，p = 0.003。MBC患者的生存率最差，即使控制了重要因素，即复发的局部。姑息性系统治疗对预后有良好的影响，男性经常避免使用姑息性系统治疗可以证明结局差异。
Male breast cancer (MBC) patients seem to have inferior survival compared to female (FBC) ones, which is not fully explained by usual prognostic factors. Recurrence analysis could show differences in relapse patterns and/or in patients' approaches that justify these outcomes. Retrospective analysis of MBC patients treated in a cancer center between 1990 and 2014, looking for relapse. For each patient, three matched FBC patients were selected by: diagnosis' year, age (within 5 years), stage and tumors' type (only luminal-like were considered). Differences between cohorts were assessed by chi(2) test and hierarchical clustering was performed to define subgroups according to relapse local. Survival curves were calculated by Kaplan-Meier and compared using log-rank test. Statistical significance was defined as p < 0.05. Groups were balanced according to age, histological grade, stage, expression of hormonal receptors and adjuvant treatments. Median time to recurrence was equivalent, p = 0.72, with the majority of patients presented with distant metastases, p = 0.69, with more lung involvement in male, p =0.003. Male patients were more often proposed to symptomatic treatment (21.1% vs. 4.4%, p = 0.02). Overall and from recurrence survivals were poorer for male, median: 5 years [95% confidence interval (CI): 4.1-5.9 years] and 1 year (95% CI: 0-2.1 years) vs. 10 years (95% CI: 7.8-12.2 years) and 2 years (95% CI: 1.6-2.4 years), p < 0.001 and p = 0.004, respectively, and this tendency remained in the five cluster subgroups, that identified five patterns of relapse, p = 0.003. MBC patients had the worst survival, even after controlling important factors, namely the local of relapse. Palliative systemic treatment had favorable impact in prognosis and its frequently avoidance in male could justify the outcomes differences.