Chest Wall Resection for Breast Cancer: 21st Century Experience

Abstract

INTRODUCTION: Male breast cancer (BC) represents <1% of all BC diagnoses. Given the rarity of this disease, limited research is available. Recent publications in female Stage IV BC have shown that surgical intervention has a survival benefit. This study aims to determine the impact of surgical intervention in men with Stage IV BC and known estrogen receptor (ER) and progesterone receptor (PR) status. METHODS:The National Cancer Database was used to identify 539 Stage IV BC patients with known ER/PR status from 2004-2017. Chi-square tests examined subgroup differences between the treatment modalities received. Overall survival (OS) was assessed using the Kaplan Meier method (Figure). Multivariate Cox proportional hazard models examined factors associated with survival.RESULTS: A survival advantage was noted in patients who received systemic therapy, surgery, and radiation (Trimodality) compared to systemic therapy alone (ST) (hazard ratio [HR] 0.622, 95% CI 0.459-0.843; p<0.0022). ER+ patients who received trimodality or ST and surgery (ST+Surg) had an improved 5-year OS rate when compared with ST (Trimodality 40%, ST+Surg 27%, ST 20%, p<0.0028). PR+ patients who received trimodality or ST+Surg had an improved 5-year OS rate when compared with ST (Trimodality 39% ST+Surg 24%, ST 20%, p<0.0325). The sequence of treatment was significant, with the greatest survival advantage noted in recipients of neoadjuvant chemotherapy (NAC) compared to adjuvant chemotherapy in ER+ patients (ER+ NAC HR 0.342, p<0.0244).CONCLUSION: Surgery with ST has a survival benefit in stage IV male BC patients with known ER/PR status and should be considered after NAC in patients with ER+ disease.