Poor prognosis of male triple-positive breast Cancer patients: a propensity score matched SEER analysis and molecular portraits

Abstract

Background The purpose of this study was to explore clinicalpathology features, molecular features and outcome of male breast cancer patients who expressed ER, PR as well as HER-2, namely triple-positive male breast cancer (TP-MBC), and compared them with triple-positive female breast cancer patients (TP-FBC). Methods TP-MBC and TP-FBC from 2010 to 2017 were selected from the Surveillance, Epidemiology, and End Results database (SEER). Kaplan-Meier plotter and multivariable Cox regression model were applied to analyse the difference between TP-MBC and TP-FBC on cancer-specific survival (CSS) and overall survival (OS). Propensity score matched (PSM) analysis was used to ensure well-balanced characteristics. 7 cases TP-MBC and 174 cases TP-FBC patients with the genomic and clinical information were identified from the cohort of The Cancer Genome Atlas (TCGA) and the Memorial Sloan Kettering (MSK). Result 336 TP-MBC and 33,339 TP-FBC patients were taken into the study. The percentages of TP-MBC in MBC patients were higher than the rates of TP-FBC in FBC patients from 2010 to 2017 except 2012. Compared with TP-FBC, more TP-MBC were staged III (17.9% vs. 13.5%) or stage IV (11.0% vs. 6.9%). TP-MBC were more frequently to be older than 65-years-old (47.0% vs. 29.3%), Balck (15.2% vs. 10.8%), ductal carcinoma (91.7% vs. 84.4%) and metastases to lung (4.5% vs. 2.1%) or bone (8.6% vs. 4.7%). TP-MBC had worse OS and CSS than TP-FBC in all stages (P < 0.001). In multivariable prediction model of TPBC, male patients had a higher risk than female. Lastly, the worse OS (P < 0.001) and CSS (P = 0.013) were seen in the 1:3 PSM analysis between TP-MBC and TP-FBC. Genomic analysis revealed that TP-MBCs have some notable rare mutations, like ERBB2, ERBB3, RB1, CDK12, FGFR2, IDH1, AGO2, GATA3, and some of them are not discovered in TP-FBC. Conclusion TP-MBC had a worse survival than TP-FBC, and there were different genomic features between two groups. Current knowledge and treatment to TP-MBC maybe inadequate and remain to be explored.

Establishment and verification of a nomogram for predicting survival in patients with triple-positive breast cancer

“…Compared to ER-PR-HER2+ breast cancer, TPBC is less invasive and HER-2 expression levels are lower (30). Among all TNBC patients, male patients have a higher aggressiveness and are more likely to have metastases than female patients (31). Trastuzumab is a key treatment strategy for TPBC patients and is also the first-line treatment option for relapsed and metastatic patients.…”

Development and validation of a prognostic nomogram model for HER2-positive male breast cancer patients

“…Studies have shown that tumor staging is an important factor affecting the survival and prognosis of tumor patients [17][18][19], especially with respect to distant metastasis, which is the main cause of death of these cancer patients. The study of Wang et al [20] showed that the T, N and M stages were prognostic factors for MBC patients. However, our study suggested that only the T and M stages affected the prognosis of these patients.…”

Is There a Survival Difference Between Male and Female Breast Cancer Subtypes According to the Prognostic Staging System? A Population-Based Cohort Study

“…23 Wang et al showed in their study, in which they compared triple-negative male and female patients using the SEER database, that the prognosis was worse in triple-negative male breast cancer patients than female patients, and it was suggested that this might be due to tumoral and individual genetic differences between the two groups. 24 The difference in epidemiological risk factors and tumor biology is one of the most important reasons for the difference in the prognosis and treatment of breast cancer in males and females. 14 As shown in our study, hormone receptor positivity is a better prognostic indicator in females, while it is associated with a poor prognosis in males.…”