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

• Published in: Critical reviews in oncology/hematology 2010-03, Vol.73 (3), p.246-254
• Main Authors: Cutuli, B, Le-Nir, C. Cohen-Solal, Serin, D, Kirova, Y, Gaci, Z, Lemanski, C, De Lafontan, B, Zoubir, M, Maingon, P, Mignotte, H, Lara, C. Tunon de, Edeline, J, Penault-Llorca, F, Romestaing, P, Delva, C, Comet, B, Belkacemi, Y
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal - therapeutic use; Aromatase inhibitors; Aromatase Inhibitors - therapeutic use; Biological and medical sciences; Breast Neoplasms, Male - diagnosis; Breast Neoplasms, Male - pathology; Breast Neoplasms, Male - surgery; Breast Neoplasms, Male - therapy; Chemotherapy; Cohort Studies; Gynecology. Andrology. Obstetrics; Hematologic and hematopoietic diseases; Hematology, Oncology and Palliative Medicine; Humans; Local recurrence; Male; Male breast cancer; Mammary gland diseases; Mastectomy; Medical sciences; Metastases; Middle Aged; Prognosis; Prognostic factors; Radiotherapy; Survival; Tamoxifen; Tamoxifen - therapeutic use; Tumors; Young Adult
• ISSN: 1040-8428; 1879-0461
• DOI: 10.1016/j.critrevonc.2009.04.002

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%, T3 T4 : 9%, T x : 11% and N1 N2 : 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%, T3 T4 : 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.