Patterns of recurrence and treatment in male breast cancer: A clue to prognosis?

Abstract

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 χ(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.

Metastasis pattern and prognosis of male breast cancer patients in US: a population-based study from SEER database

“…At present, it is believed that it is mainly lack of awareness of breast cancer in male patients or delays in diagnosis that might be the cause of this phenomenon. 7,18,19 A study found that only 29% of 100 Croatian MBC patients were diagnosed 20 In addition, Hong and colleagues suggested that the prolonged period of symptom duration of MBC was also the reason for the difference in the rate of distant metastasis between MBC and FBC patients, 17 and NI and colleagues' study of 64 cases of male breasts without breast cancer showed columnar cell changes in 39 cases (61%), which was considered to be a transitional stage in the development of some low-grade ductal carcinoma in situ and invasive breast cancer. 21 In our opinion, in addition to the above reasons, differences in gene mutation may also cause this phenomenon.…”

Ghrelin expression is associated with a favorable outcome in male breast cancer

“…Whether there is a difference in prognosis compared with FBC is debatable. A poorer outcome has been indicated in several studies 6 – 8 , but also similar 9 , 10 or even better prognosis than FBC 11 have been reported. Studies on genomic and transcriptional levels have demonstrated molecular differences between MBC and FBC.…”

Metastatic Breast Carcinoma to the Superior Oblique in a Male

“…Male breast cancer is a rare condition that can have higher mortality compared to the female equivalent [ 2 , 8 ]. Male breast cancer has unique characteristics that differ from their female counterparts.…”