1
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Gao Y, Zhang M, Sun G, Ma L, Nie J, Yuan Z, Liu Z, Cao Y, Li J, Liu Q, Ye S, Chen B, Song Y, Wang K, Ren Y, Ye G, Xu L, Liu S, Chen Q, Li W, Chen X, Fu P, Wei W, Guo B, Wang H, Cai Z, Du C, Wu Z, Zha X, Huang H, Xu J, Zhang C, Shi Y, Liu T, Liu S, Jiang Z, Lin Y. The features of male breast cancer in China: A real-world study. Breast 2024; 76:103762. [PMID: 38924994 PMCID: PMC11259957 DOI: 10.1016/j.breast.2024.103762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Male breast cancer (MBC) is a rare disease. Although several large-scale studies have investigated MBC patients in other countries, the features of MBC patients in China have not been fully explored. This study aims to explore the features of Chinese MBC patients comprehensively. METHODS We retrospectively collected data of MBC patients from 36 centers in China. Overall survival (OS) was evaluated by the Kaplan-Meier method, log-rank test, and Cox regression analyses. Multivariate Cox analyses were used to identify independent prognostic factors of the patients. RESULTS In total, 1119 patients were included. The mean age at diagnosis was 60.9 years, and a significant extension over time was observed (P < 0.001). The majority of the patients (89.1 %) received mastectomy. Sentinel lymph node biopsy was performed in 7.8 % of the patients diagnosed in 2009 or earlier, and this percentage increased significantly to 38.8 % in 2020 or later (P < 0.001). The five-year OS rate for the population was 85.5 % [95 % confidence interval (CI), 82.8 %-88.4 %]. Multivariate Cox analysis identified taxane-based [T-based, hazard ratio (HR) = 0.32, 95 % CI, 0.13 to 0.78, P = 0.012] and anthracycline plus taxane-based (A + T-based, HR = 0.47, 95 % CI, 0.23 to 0.96, P = 0.037) regimens as independent protective factors for OS. However, the anthracycline-based regimen showed no significance in outcome (P = 0.175). CONCLUSION As the most extensive MBC study in China, we described the characteristics, treatment and prognosis of Chinese MBC population comprehensively. T-based and A + T-based regimens were protective factors for OS in these patients. More research is required for this population.
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Affiliation(s)
- Yuxuan Gao
- Breast Disease Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Mengmeng Zhang
- Breast Disease Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Gang Sun
- Department of Breast and Thyroid Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, China.
| | - Li Ma
- Department of Breast Surgery, Hebei Provincial Tumor Hospital, Shijiazhuang, China.
| | - Jianyun Nie
- Breast Cancer Institute, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, China.
| | - Zhongyu Yuan
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Zhenzhen Liu
- Department of Breast Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China.
| | - Yali Cao
- Prevention and Cure Center of Breast Disease, The Third Hospital of Nanchang City, Nanchang, China.
| | - Jianbin Li
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Qiang Liu
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Songqing Ye
- Department of Tumor Surgery, Fujian Provincial Hospital, Fuzhou, China.
| | - Bo Chen
- The Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China.
| | - Yuhua Song
- Breast Center B Ward, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Yu Ren
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Guolin Ye
- Department of Breast Surgery, The First People's Hospital of Foshan, Foshan, China.
| | - Ling Xu
- Department of Thyroid and Breast Surgery, Peking University First Hospital, Beijing, China.
| | - Shu Liu
- Department of Breast Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
| | - Qianjun Chen
- Department of Breast Disease, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Weiwen Li
- Department of Breast, Jiangmen Central Hospital, Jiangmen, China.
| | - Xinxin Chen
- Department of Breast Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Peifen Fu
- Department of Breast Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.
| | - Wei Wei
- Peking University Shenzhen Hospital, Shenzhen, China.
| | - Baoliang Guo
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin City, China.
| | - Hebing Wang
- Department of Breast Surgery, Affiliated Sanming First Hospital of Fujian Medical University, Sanming, China.
| | | | - Caiwen Du
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
| | - Zhiyong Wu
- Diagnosis and Treatment Center of Breast Diseases, Shantou Central Hospital, Shantou, China.
| | - Xiaoming Zha
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Heng Huang
- Department of Breast Oncology, Lianjiang Pepole's Hospital, Lianjiang, China.
| | - Juan Xu
- Guangdong Women and Children Hospital, Guangzhou, China.
| | - Chenglei Zhang
- Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, China.
| | - Yingying Shi
- Department of Breast Disease, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai City, China.
| | - Ting Liu
- Breast Disease Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Sihua Liu
- Breast Disease Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Zefei Jiang
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Ying Lin
- Breast Disease Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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2
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Avila J, Leone J, Vallejo CT, Leone JP. Survival Analysis of Male Patients with Brain Metastases at Initial Breast Cancer Diagnosis over the Last Decade. Med Sci (Basel) 2024; 12:15. [PMID: 38535156 PMCID: PMC10972010 DOI: 10.3390/medsci12010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 08/25/2024] Open
Abstract
Breast cancer in men represents approximately 1% of all breast cancer diagnoses. Among all patients with breast cancer, approximately 30% will develop brain metastases. Over the past decade, there have been multiple advances in the treatment of metastatic breast cancer; however, long-term outcomes of this presentation in male patients are lacking. We evaluated male patients with de novo stage IV breast cancer using the Surveillance, Epidemiology and End Results (SEER) database from 2010 to 2019. Overall survival (OS) was estimated using the Kaplan-Meier method and differences between groups were compared using log rank tests. In total, 22 male patients with brain metastases at initial breast cancer diagnosis were included. Patients with HR-positive/HER2-negative tumors had the longest OS (median 13 months). Factors associated with shorter overall survival were advanced age, unmarried marital status, lower household income, and grade III disease, among others. Brain metastases remains an unmet medical need for patients with breast cancer; the development of new drugs may provide an improvement in overall survival for male patients in the future.
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Affiliation(s)
- Jorge Avila
- Department of Medicine, St Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA;
| | - Julieta Leone
- Grupo Oncológico Cooperativo Del Sur (GOCS), Neuquén Q8300HDH, Argentina
| | - Carlos T. Vallejo
- Grupo Oncológico Cooperativo Del Sur (GOCS), Neuquén Q8300HDH, Argentina
| | - José P. Leone
- Medical Oncology, Dana-Farber Cancer Institute, Susan F. Smith Center for Women’s Cancer, Harvard Medical School, Boston, MA 02215, USA
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3
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Accomasso F, Actis S, Minella C, Rosso R, Granaglia C, Ponzone R, Biglia N, Bounous VE. Clinical, Pathological, and Prognostic Features of Male Breast Cancer: A Multicenter Study. Curr Oncol 2023; 30:9860-9871. [PMID: 37999136 PMCID: PMC10670254 DOI: 10.3390/curroncol30110716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
Male breast cancer (BC) represents less than 1% of male tumors. Little is known about male BC characteristics, management, and survival, with many studies based on a small number of cases. Consequently, the treatment of male BC lacks specific guidelines. The aims of the study are to compare male and female breast cancer (FBC) in terms of cancer clinical and anatomopathological features and treatment approach, and to identify differences between male BC and FBC in terms of survival. Patients and methods: Data from 2006 to 2018 were retrospectively acquired. Amounts of 49 males and 680 postmenopausal females with primary non-metastatic BC who underwent breast surgery at Mauriziano Hospital or IRCCS Candiolo (TO-Italy) were included. The mean age at diagnosis for male BC was 68.6 years, and males presented a smaller tumor size than women (p < 0.05) at diagnosis. Most male BC patients received adjuvant endocrine therapy (AET) with tamoxifen (73.5%). AET drop-out rate due to side effects was 16.3% for males compared to 7.6% for women (p = 0.04). Comparing FBC and male BC, no differences have been identified in terms of DFS and OS, with a similar 10-year-relapse rate (12% male BC vs. 12.4% FBC). Propensity Score Matching by age, nodal status, pT, and molecular subtype had been performed and no differences in OS and DFS were seen between male BC and FBC. In conclusion, male BC and FBC have similar prognostic factors and survival outcomes. The drop-out rate of AET was higher in males, and side effects were the main reason for drug discontinuation.
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Affiliation(s)
- Francesca Accomasso
- Gynecology and Obstetrics Unit, Mauriziano Umberto I Hospital, Department of Surgical Sciences, University of Turin, 10128 Turin, Italy; (F.A.); (S.A.); (C.M.); (R.R.); (V.E.B.)
| | - Silvia Actis
- Gynecology and Obstetrics Unit, Mauriziano Umberto I Hospital, Department of Surgical Sciences, University of Turin, 10128 Turin, Italy; (F.A.); (S.A.); (C.M.); (R.R.); (V.E.B.)
| | - Carola Minella
- Gynecology and Obstetrics Unit, Mauriziano Umberto I Hospital, Department of Surgical Sciences, University of Turin, 10128 Turin, Italy; (F.A.); (S.A.); (C.M.); (R.R.); (V.E.B.)
| | - Roberta Rosso
- Gynecology and Obstetrics Unit, Mauriziano Umberto I Hospital, Department of Surgical Sciences, University of Turin, 10128 Turin, Italy; (F.A.); (S.A.); (C.M.); (R.R.); (V.E.B.)
| | - Claudia Granaglia
- Department of Surgical Sciences, University of Turin, 10124 Torino, Italy
| | | | - Nicoletta Biglia
- Gynecology and Obstetrics Unit, Mauriziano Umberto I Hospital, Department of Surgical Sciences, University of Turin, 10128 Turin, Italy; (F.A.); (S.A.); (C.M.); (R.R.); (V.E.B.)
| | - Valentina Elisabetta Bounous
- Gynecology and Obstetrics Unit, Mauriziano Umberto I Hospital, Department of Surgical Sciences, University of Turin, 10128 Turin, Italy; (F.A.); (S.A.); (C.M.); (R.R.); (V.E.B.)
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4
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Fentiman IS. Prognostic difficulties of men with breast cancer. Breast J 2021; 27:877-882. [PMID: 34652050 DOI: 10.1111/tbj.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
Most adequately powered studies confirm a worse prognosis for males versus matched females with breast cancer. There is in-stage migration for stage I cancers with a different ratio of tumor/normal breast tissue in males. Younger men have a better prognosis, largely the result of increased morbidity in the elderly, exacerbated by smoking, low socioeconomic differences, and ethnic disparity. BRCA2 carriers with MBC have a worse outcome than noncarriers as do men with amplification of EMSY. Men with tumors having a high cytosol level of plasminogen activator inhibitor 1 (PAI-1) may have more invasive cancers leading to earlier spread and hence a worse outcome. PREDICT+ is a useful prognostic model for MBC and multigene testing enables more specific systemic therapies to be used.
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Affiliation(s)
- Ian S Fentiman
- Professor of Surgical Oncology, Research Oncology, Guy's Hospital, London, UK
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5
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Li B, Zhao X, Zhang L, Cheng W. Differences in ultrasonographic features between males and females with breast cancer of the luminal A and luminal B molecular subtypes. Asia Pac J Clin Oncol 2021; 18:e255-e262. [PMID: 34310058 DOI: 10.1111/ajco.13597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/13/2021] [Indexed: 11/28/2022]
Abstract
AIM To analyze the relationships between the ultrasonographic features and the molecular subtypes of breast cancer in men and women. METHODS Data were collected from 43 males and 80 females with breast cancer who were treated at our hospital. The following ultrasonographic characteristics of the tumors were evaluated: shape, orientation, margin, echo pattern, posterior features, calcifications, Color Doppler Flow Imaging, and Breast Imaging Reporting and Data System (BI-RADS) category. RESULTS On ultrasound, a nonparallel orientation, noncircumscribed margin, and attenuating posterior features were associated with luminal A lesions. A parallel orientation (P = 0.002), circumscribed margin (P = 0.04), no change in posterior features (P < 0.001), and the BI-RADS 4 category (P = 0.001) were significantly associated with luminal B lesions. In the group with luminal A lesions, male patients were older (P = 0.001) and a greater number of the tumors exhibited a regular shape (P = 0.009), circumscribed margin (P < 0.001), no change in posterior features (P < 0.001), and the BI-RADS 4 category (P < 0.001) than those in female patients. Male patients were older (P < 0.001) and a greater number showed a no change in posterior features (P < 0.001), spotty blood flow (P = 0.002), and the BI-RADS 4 category (P < 0.001) than female patients with masses of the luminal B subtype. CONCLUSION Obvious differences in the ultrasonographic and pathological features were noted between breast cancer in males and females, which provided the theoretical basis for the individualized treatment of breast cancer, particularly breast cancer in males.
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Affiliation(s)
- Bo Li
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xin Zhao
- Department of Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lei Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
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6
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Gomig THB, Gontarski AM, Cavalli IJ, Souza RLRD, Lucena ACR, Batista M, Machado KC, Marchini FK, Marchi FA, Lima RS, Urban CDA, Marchi RD, Cavalli LR, Ribeiro EMDSF. Integrated analysis of label-free quantitative proteomics and bioinformatics reveal insights into signaling pathways in male breast cancer. Genet Mol Biol 2021; 44:e20190410. [PMID: 33656060 PMCID: PMC7926483 DOI: 10.1590/1678-4685-gmb-2019-0410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/18/2021] [Indexed: 01/04/2023] Open
Abstract
Male breast cancer (MBC) is a rare malignancy that accounts for about 1.8% of all breast cancer cases. In contrast to the high number of the “omics” studies in breast cancer in women, only recently molecular approaches have been performed in MBC research. High-throughput proteomics based methodologies are promisor strategies to characterize the MBC proteomic signatures and their association with clinico-pathological parameters. In this study, the label-free quantification-mass spectrometry and bioinformatics approaches were applied to analyze the proteomic profiling of a MBC case using the primary breast tumor and the corresponding axillary metastatic lymph nodes and adjacent non-tumor breast tissues. The differentially expressed proteins were identified in the signaling pathways of granzyme B, sirtuins, eIF2, actin cytoskeleton, eNOS, acute phase response and calcium and were connected to the upstream regulators MYC, PI3K SMARCA4 and cancer-related chemical drugs. An additional proteomic comparative analysis was performed with a primary breast tumor of a female patient and revealed an interesting set of proteins, which were mainly involved in cancer biology. Together, our data provide a relevant data source for the MBC research that can help the therapeutic strategies for its management.
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Affiliation(s)
| | - Amanda Moletta Gontarski
- Universidade Federal do Paraná, Departamento de Genética, Programa de Pós-graduação em Genética, Curitiba, PR, Brazil
| | - Iglenir João Cavalli
- Universidade Federal do Paraná, Departamento de Genética, Programa de Pós-graduação em Genética, Curitiba, PR, Brazil
| | | | | | - Michel Batista
- Instituto Carlos Chagas, Laboratório de Genômica Funcional, Curitiba, PR, Brazil.,Fundação Oswaldo Cruz (Fiocruz), Plataforma de Espectrometria de Massas, Curitiba, PR, Brazil
| | | | - Fabricio Klerynton Marchini
- Instituto Carlos Chagas, Laboratório de Genômica Funcional, Curitiba, PR, Brazil.,Fundação Oswaldo Cruz (Fiocruz), Plataforma de Espectrometria de Massas, Curitiba, PR, Brazil
| | | | - Rubens Silveira Lima
- Hospital Nossa Senhora das Graças, Centro de Doenças da Mama, Curitiba, PR, Brazil
| | | | | | - Luciane Regina Cavalli
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil.,Georgetown University, Lombardi Comprehensive Cancer Center, Washington, USA
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7
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Ansari N, Shahrabi S, Khosravi A, Shirzad R, Rezaeean H. Prognostic Significance of CHEK2 Mutation in Progression of Breast Cancer. Lab Med 2019; 50:e36-e41. [PMID: 31220302 DOI: 10.1093/labmed/lmz009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Breast cancer (BC) is one of the most common cancers among women; genetic mutations reflect the development of this disease. Mutations in cell signaling factors can be the main cause of BC development. In this study, we focused on mutations in checkpoint kinase 2 (CHEK2) and their impact as a prognostic factor in the pathogenesis of BC. CHEK2 is controlled in cell signaling pathways through the influence of upstream genes. Also, several downstream genes are regulated by CHEK2. In addition, mutations in CHEK2 lead to resistance of BC cells to chemotherapy and metastasis of cancer cells to other parts of the body. Finally, detection of mutations in CHEK2 can be used as a prognostic factor for patient response to treatment and for targeting downstream molecules of CHEK2 that are involved in the proliferation of breast tumor cells. Mutations such as c.1100delC and I157T can distinguish which patients are susceptible to metastasis.
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Affiliation(s)
- Narges Ansari
- Isfahan Bone Metabolic Disorders Research Center, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeid Shahrabi
- Department of Hematology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Abbas Khosravi
- Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Reza Shirzad
- Research Center of Thalassemia & Hemoglobinopathy, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hadi Rezaeean
- Research Center of Thalassemia & Hemoglobinopathy, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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8
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Overall Survival of Men and Women With Breast Cancer According to Tumor Subtype: A Population-based Study. Am J Clin Oncol 2019; 42:215-220. [PMID: 30499840 DOI: 10.1097/coc.0000000000000497] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To analyze differences in overall survival (OS) between male breast cancer (MBC) and female breast cancer (FBC) according to tumor subtype compared with other factors. MATERIALS AND METHODS We evaluated men and women with breast cancer between 2010 and 2013 with known hormone receptor (HR) status and human epidermal growth factor receptor 2 (HER2) status reported to the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Patient characteristics were compared between groups. Univariate and multivariate analyses were performed to determine the effect of each variable on OS. Breast cancer-specific survival was a secondary endpoint. RESULTS We included 1187 MBC and 166,054 FBC. Median follow-up was 21 months (range, 1 to 48) for both groups. OS at 3 years for MBC and FBC was 85.6% and 90.4%, respectively (P=0.0002). MBC were more ductal, had higher grade, presented with more advanced stage and were often HR+/HER2- (each P<0.0001). MBC had worse OS than FBC in HR+/HER2- (Hazard ratio [HaR], 1.5; P=0.0005), HR+/HER2+ (HaR, 2.8; P<0.0001) and triple negative (HaR, 4.3; P<0.0001) (Pinteraction<0.02). MBC had significantly worse OS than FBC in stages I and II, but similar OS in stages III and IV (Pinteraction<0.01). In multivariate analysis, HR+/HER2+ was the only subtype with significant differences in OS between MBC and FBC (HaR, 2.0; P=0.002). CONCLUSIONS OS was significantly different in both groups. Men had worse OS in early stages while similar OS in stages III and IV. There were significant differences in OS according to tumor subtype; compared with women, men with HR+/HER2+ tumors had twice the risk of death.
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9
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Wang Y, Chen K, Yang Y, Tan L, Chen L, Zhu L, Su F, Liu X, Li S. Incidence and survival outcomes of early male breast cancer: a population-based comparison with early female breast cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:536. [PMID: 31807518 DOI: 10.21037/atm.2019.10.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Male breast cancer (MBC) is a rare malignancy. We aimed to analyze the incidence trends, clinicopathological characteristics, and survival outcomes in early MBC comparison with early female breast cancer (FBC). Methods We included eligible MBC and FBC patients with stage I-II disease in the Surveillance, Epidemiology, and End Results (SEER) database from 2000-2015. Joinpoint regression was used to evaluate the trends in age-adjusted incidence. A one-to-four propensity score matching (PSM) analysis was performed to reduce bias in a retrospective study. Survival outcomes were evaluated using Kaplan-Meier analyses with the log-rank test and Cox proportional hazards regression analysis. Results Trends in the age-adjusted incidence rates of early MBC were stable [2000-2015, annual percentage change (APC) =0.50, 95% confidence interval (CI): -0.1 to 1.1, P=0.102]; however, the incidence of early FBC changed significantly over the time period (2000-2015, APC = 0.30, 95% CI: 0.0 to 0.6, P=0.045). In the matched cohort, unmarried status, higher grade, larger tumor size, and advanced lymph node (LN) status were associated with a higher risk of breast cancer death and death of any causes both in early MBC and FBC patients. The hormone receptor (HR) status was as a prognostic factor in FBC patients, but not in MBC. Early MBC had worse breast cancer-specific survival (BCSS) and overall survival (OS) than early FBC in stage I, stage II and HR-positive subgroup of patients. Conclusions The biological behavior, clinicopathological features, and clinical outcomes of early MBC are different from that of FBC. Further studies on individualized treatment approaches in MBC are needed.
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Affiliation(s)
- Yan Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Luyuan Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Lili Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Liling Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Fengxi Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xue Liu
- College of Basic Medicine, Jining Medical University, Jining 272067, China
| | - Shunrong Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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10
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André S, Pereira T, Silva F, Machado P, Vaz F, Aparício M, Silva GL, Pinto AE. Male breast cancer: Specific biological characteristics and survival in a Portuguese cohort. Mol Clin Oncol 2019; 10:644-654. [PMID: 31031981 PMCID: PMC6482395 DOI: 10.3892/mco.2019.1841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 03/29/2019] [Indexed: 12/12/2022] Open
Abstract
Male breast cancer (BC) represents an individual subtype of BC, with therapeutic procedures based on female BC therapy results. The present study evaluated the parameters currently used for the characterization and therapy of male BC, and their association with disease-free (DFS) and overall survival (OS), aiming to obtain a comprehensive basis to improve the personalized care of male BC. A total of 196 patients from March 1970 to March 2018 (mean follow-up, 84.9 months) were profiled, using clinicopathological review, molecular assessment [BRCA1/2, DNA repair associated (BRCA1/2) status, immunohistochemistry, fluorescence in situ hybridization and DNA flow cytometry] and Cox regression statistical analysis. The median age of patients was 66.5 years. At presentation, 39.2% of patients with invasive carcinomas were in anatomic stage (AS) I. Patients exhibited primarily invasive carcinomas of no special type, histological grade 2, estrogen receptor α-(ERα) and progesterone receptor (PR)-positive, receptor tyrosine kinase erbB-2-negative, high Ki-67, Luminal B-like and aneuploid tumors. A total of 13 of the 44 (29.5%) BRCA-evaluated patients exhibited BRCA2 mutations, significantly associated with family history (FH), bilaterality, high Ki-67 expression, absence of PR and Luminal B-like tumors. Bilaterality was associated with the occurrence of non-breast primary neoplasms (NBPN). The 5 and 10-year DFS rates, excluding patients with distant metastasis, NBPN and in situ carcinomas (n=145) were 65.9 and 58.2%, respectively, and the 5 and 10-year OS rates were 77.5 and 59.2%, respectively. In the univariate analysis, Luminal B-like subtype, BRCA2 mutations, high Ki-67 expression, and AS II and III were significantly associated with shorter DFS and OS. In addition, age >70 years was associated with low OS. In the multivariate analysis, FH, AS II and III, and Luminal B-like subtypes were associated with poorer OS. In conclusion, the data from the present study emphasize the high incidence of BRCA2 mutation in male BC, and its association with FH, bilaterality, high Ki-67 expression, negative PR expression and Luminal B-like subtypes, and with shorter DFS and OS in univariate analysis.
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Affiliation(s)
- Saudade André
- Department of Pathology, Portuguese Institute of Oncology of Lisbon, 1099-023 Lisbon, Portugal
| | - Teresa Pereira
- Department of Pathology, Portuguese Institute of Oncology of Lisbon, 1099-023 Lisbon, Portugal
| | - Fernanda Silva
- NOVA Medical School, NOVA University, 1169-056 Lisbon, Portugal
| | - Patrícia Machado
- Breast Cancer Risk Evaluation Clinic, Portuguese Institute of Oncology of Lisbon, 1099-023 Lisbon, Portugal
| | - Fátima Vaz
- Breast Cancer Risk Evaluation Clinic, Portuguese Institute of Oncology of Lisbon, 1099-023 Lisbon, Portugal
| | - Mariana Aparício
- Department of Mathematics of Higher Technical Institute, University of Lisbon, Portugal
| | - Giovani L. Silva
- Department of Mathematics of Higher Technical Institute, University of Lisbon, Portugal
- Statistics and Applications Center of University of Lisbon, 1049-001 Lisbon, Portugal
| | - António E. Pinto
- Department of Pathology, Portuguese Institute of Oncology of Lisbon, 1099-023 Lisbon, Portugal
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11
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Maajani K, Jalali A, Alipour S, Khodadost M, Tohidinik HR, Yazdani K. The Global and Regional Survival Rate of Women With Breast Cancer: A Systematic Review and Meta-analysis. Clin Breast Cancer 2019; 19:165-177. [PMID: 30952546 DOI: 10.1016/j.clbc.2019.01.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/10/2019] [Accepted: 01/19/2019] [Indexed: 12/22/2022]
Abstract
Breast cancer is the most common cancer among women in the world. The aim of this study was to measure the global and regional survival rates of women with breast cancer. We searched Medline/PubMed, Web of Science, Scopus, and Google Scholar to identify cohort studies on the survival rate of women with primary invasive breast cancer until the end of June 2017. We used random effect models to estimate the pooled 1-, 3-, 5-, and 10-year survival rates. Subgroup analysis and meta-regression models were used to investigate the potential sources of heterogeneity. One hundred twenty-six studies were included in the meta-analysis. Between-study heterogeneities in the 1-, 3-, 5-, and 10-year survival rates were significantly high (all I2s > 50%; P = .001). The global 1-, 3-, 5-, and 10-year pooled survival rates in women with breast cancer were 0.92 (95% confidence interval [CI], 0.90-0.94), 0.75 (95% CI, 0.71-0.79), 0.73 (95% CI, 0.71-0.75), and 0.61% (95% CI, 0.54-0.67), respectively. Subgroup analysis revealed that survival rates varied in different World Health Organization regions, age and stage at diagnosis, year of the studies, and degree of development of countries. Meta-regression indicated that year of the study (β = 0.07; P = .002) and development of country (β = -0.1; P = .0001) were potential sources of heterogeneity. The survival rate was improved in recent decades; however, it is lower in developing regions than developed ones.
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Affiliation(s)
- Khadije Maajani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf Alipour
- Breast Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Surgery, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Khodadost
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Gerash University of Medical Sciences, Gerash, Iran
| | - Hamid Reza Tohidinik
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kamran Yazdani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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12
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Mannu GS, Gammer B, Bettencourt-Silva JH, Tsoti SM, Wekesa W, Ahmed SF, Cunnick G. Prognostic factors for male breast cancer: A breast center's 10-year experience. Breast J 2018; 24:1116-1117. [PMID: 30062686 DOI: 10.1111/tbj.13081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - Wangia Wekesa
- Buckinghamshire NHS Healthcare Trust, Buckinghamshire, UK
| | - Sk Farid Ahmed
- Buckinghamshire NHS Healthcare Trust, Buckinghamshire, UK
| | - Giles Cunnick
- Buckinghamshire NHS Healthcare Trust, Buckinghamshire, UK
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13
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Grönberg M, Nilsson C, Markholm I, Hedenfalk I, Blomqvist C, Holmberg L, Tiensuu Janson E, Fjällskog ML. Ghrelin expression is associated with a favorable outcome in male breast cancer. Sci Rep 2018; 8:13586. [PMID: 30206250 PMCID: PMC6134078 DOI: 10.1038/s41598-018-31783-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/24/2018] [Indexed: 12/11/2022] Open
Abstract
Ghrelin and obestatin are two gastrointestinal peptides, derived from a common precursor. Expression of both peptides have been found in breast cancer tissue and ghrelin has been associated with breast cancer development. Ghrelin expression is associated with longer survival in women diagnosed with invasive and node negative breast cancer. The clinical implications of the peptide expression in male breast cancer are unclear. The aim of this study was to investigate the role and potential clinical value of ghrelin and obestatin in male breast cancer. A tissue microarray of invasive male breast cancer specimens from 197 patients was immunostained with antibodies versus the two peptides. The expression of the peptides was correlated to previously known prognostic factors in breast cancer and to the outcome. No strong correlations were found between ghrelin or obestatin expression and other known prognostic factors. Only ghrelin expression was statistically significantly correlated to breast cancer-specific survival (HR 0.39, 95% CI 0.18–0.83) in univariate analyses and in multivariate models, adjusted for tumor size and node status (HR 0.38, 95% CI 0.17–0.87). HR for obestatin was 0.38 (95% CI 0.11–1.24). Ghrelin is a potential prognostic factor for breast cancer death in male breast cancer. Patients with tumors expressing ghrelin have a 2.5-fold lower risk for breast cancer death than those lacking ghrelin expression. Drugs targeting ghrelin are currently being investigated in clinical studies treating metabolic or nutritional disorders. Ghrelin should be further evaluated in forthcoming studies as a prognostic marker with the aim to be included in decision algorithms.
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Affiliation(s)
- Malin Grönberg
- Department of Medical Sciences, Section of Endocrine Oncology, Uppsala University, Uppsala, Sweden.
| | - Cecilia Nilsson
- Center for Clinical Research, Västmanland County Hospital, Västerås, Sweden
| | - Ida Markholm
- Division of Oncology and Pathology, Department of Clinical Sciences, and CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, and CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Carl Blomqvist
- Department of Oncology, Helsinki University, Helsinki, Finland.,Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Lars Holmberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Eva Tiensuu Janson
- Department of Medical Sciences, Section of Endocrine Oncology, Uppsala University, Uppsala, Sweden
| | - Marie-Louise Fjällskog
- Department of Medical Sciences, Section of Endocrine Oncology, Uppsala University, Uppsala, Sweden
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14
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Gao Y, Heller SL, Moy L. Male Breast Cancer in the Age of Genetic Testing: An Opportunity for Early Detection, Tailored Therapy, and Surveillance. Radiographics 2018; 38:1289-1311. [PMID: 30074858 DOI: 10.1148/rg.2018180013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In detection, treatment, and follow-up, male breast cancer has historically lagged behind female breast cancer. On the whole, breast cancer is less common among men than among women, limiting utility of screening, yet the incidence of male breast cancer is rising, and there are men at high risk for breast cancer. While women at high risk for breast cancer are well characterized, with clearly established guidelines for screening, supplemental screening, risk prevention, counseling, and advocacy, men at high risk for breast cancer are poorly identified and represent a blind spot in public health. Today, more standardized genetic counseling and wider availability of genetic testing are allowing identification of high-risk male relatives of women with breast cancer, as well as men with genetic mutations predisposing to breast cancer. This could provide a new opportunity to update our approach to male breast cancer. This article reviews male breast cancer demographics, risk factors, tumor biology, and oncogenetics; recognizes how male breast cancer differs from its female counterpart; highlights its diagnostic challenges; discusses the implications of the widening clinical use of multigene panel testing; outlines current National Comprehensive Cancer Network guidelines (version 1, 2018) for high-risk men; and explores the possible utility of targeted screening and surveillance. Understanding the current state of male breast cancer management and its challenges is important to shape future considerations for care. Shifting the paradigm of male breast cancer detection toward targeted precision medicine may be the answer to improving clinical outcomes of this uncommon disease. ©RSNA, 2018.
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Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., S.L.H., L.M.); and the Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (L.M.)
| | - Samantha L Heller
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., S.L.H., L.M.); and the Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (L.M.)
| | - Linda Moy
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., S.L.H., L.M.); and the Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (L.M.)
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15
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Liu N, Johnson KJ, Ma CX. Male Breast Cancer: An Updated Surveillance, Epidemiology, and End Results Data Analysis. Clin Breast Cancer 2018; 18:e997-e1002. [PMID: 30007834 DOI: 10.1016/j.clbc.2018.06.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/24/2018] [Accepted: 06/19/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Male breast cancer is rare and understudied compared with female breast cancer. A current comparison with female breast cancer could assist in bridging this gap. Although conflicting data have been reported on male and female survival outcomes, data from 1973 through 2005 in the Surveillance, Epidemiology, and End Results (SEER) program have demonstrated that the improvement in breast cancer survival in men has fallen behind that of women. As treatment for breast cancer has improved significantly, an updated analysis using a contemporary population is necessary. MATERIALS AND METHODS An analysis of SEER data from patients with a diagnosis of primary breast cancer from 2005 to 2010 were included. A Cox regression model was used to examine the association between sex and breast cancer mortality after controlling for prognostic factors, including age, race, marital status, disease stage, estrogen and progesterone receptor status, lymph node involvement, tumor grade, surgery, and geography. Subgroup analyses were performed by race and stage. RESULTS We included a total of 289,673 breast cancer cases (2054 men) with a diagnosis from 2005 to 2010. The 5-year survival rate for male patients was lower than that for female patients (82.8% vs. 88.5%). After controlling for other factors, the risk of death in men was 43% greater than that in women during the follow-up period (hazard ratio, 1.43; 95% confidence interval, 1.26-1.61). Similar results were noted in the race and stage subgroup analyses. CONCLUSION In recent years, male breast cancer patients have had worse survival outcomes compared with those of female patients.
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Affiliation(s)
- Ning Liu
- Washington University Brown School of Public Health, St. Louis, MO
| | - Kimberly J Johnson
- Washington University Brown School of Public Health, St. Louis, MO; Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Cynthia X Ma
- Washington University Brown School of Public Health, St. Louis, MO; Section of Medical Oncology, Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
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16
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Wang J, Yan F, Wang Y, Sheng Y, Li H. The Survival Time of 8376 Male Breast Cancer Patients. Clin Oncol (R Coll Radiol) 2018; 30:596-597. [PMID: 29857971 DOI: 10.1016/j.clon.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/16/2018] [Indexed: 11/18/2022]
Affiliation(s)
- J Wang
- Basic Medical College, Navy Medical University, Shanghai, China
| | - F Yan
- Basic Medical College, Navy Medical University, Shanghai, China
| | - Y Wang
- Department of Oncology, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Y Sheng
- Department of Thyroid and Breast Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - H Li
- Department of Thyroid and Breast Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
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17
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Lautrup MD, Thorup SS, Jensen V, Bokmand S, Haugaard K, Hoejris I, Jylling AMB, Joernsgaard H, Lelkaitis G, Oldenburg MH, Qvamme GM, Soee K, Christiansen P. Male breast cancer: a nation-wide population-based comparison with female breast cancer. Acta Oncol 2018; 57:613-621. [PMID: 29276849 DOI: 10.1080/0284186x.2017.1418088] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Describe prognostic parameters of Danish male breast cancer patients (MBCP) diagnosed from 1980-2009. Determine all-cause mortality compared to the general male population and analyze survival/mortality compared with Danish female breast cancer patients (FBCP) in the same period. MATERIAL AND METHODS The MBCP cohort was defined from three national registers. Data was extracted from medical journals. Data for FBCP is from the DBCG database. Overall survival (OS) was quantified by Kaplan-Meier estimates. Standardized mortality ratios (SMRs) were calculated based on mortality rate among patients relative to the mortality rate in the general population. The association between SMR and risk factors were analyzed in univariate and multivariable Poisson regression models. Separate models for each gender were used for the analyses. RESULTS We found a marked difference in OS for the two genders. For the total population of MBCP, 5- and 10-year survivals were 55.1% and 31.7%, respectively. For FBCP, the corresponding figures were 76.8% and 59.3%. Median age at diagnosis for FBCP was 61 years and 70 years for MBCP. By applying SMR, the difference in mortality between genders equalized and showed pronounced age-dependency. For males <40 years, SMR was 9.43 and for females 19.56 compared to SMR for males 80 + years (0.95) and females 80 + years (0.89). During the period 1980-2009, the risk of dying gradually decreased for FBCP (p < .0001). The risk 1980-1984 was 35% higher than 2005-2009 (RR 1.35). Although the risk of dying for MBCP was also lowest in 2005-2009, there was no clear tendency (p = .1439). The risk was highest in 1990-1994 (RR =2.48). CONCLUSION We found better OS for FBCP than for MBCP. But SMR showed similar mortality rate for the two genders, except for very young FBCP, who had higher SMR. Furthermore, significantly improved survival over time for FBCP was observed, with no clear tendency for MBCP.
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Affiliation(s)
- Marianne D. Lautrup
- Department of Organ and Plastic Surgery, Breast Centre, Lillebaelt Hospital, Vejle, Denmark
| | - Signe S. Thorup
- Department 2501, DBCG-Secretary, Rigshospitalet, Copenhagen, Denmark
| | - Vibeke Jensen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Bokmand
- Department of Breast Surgery, Copenhagen University Hospital, Herlev, Denmark
| | - Karen Haugaard
- Department of Breast Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Inger Hoejris
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hjoerdis Joernsgaard
- Department of Organ and Plastic Surgery, Breast Centre, Sydvestjyst Hospital, Esbjerg, Denmark
| | | | | | - Gro M. Qvamme
- Department of Breast Surgery, Copenhagen University Hospital, Herlev, Denmark
| | - Katrine Soee
- Department of Plastic Surgery, Breast Surgery Unit, Odense University Hospital, Odense, Denmark
| | - Peer Christiansen
- Aarhus University Hospital/Randers Regional Hospital, Breast Surgery Unit, Aarhus, Denmark
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18
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Chen W, Huang Y, Lewis GD, Szeja SS, Hatch SS, Farach A, Miltenburg D, Butler EB, Chang JC, Teh BS. Treatment Outcomes and Prognostic Factors in Male Patients With Stage IV Breast Cancer: A Population-based Study. Clin Breast Cancer 2017; 18:e97-e105. [PMID: 28888581 DOI: 10.1016/j.clbc.2017.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/15/2017] [Accepted: 07/09/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Male breast cancer (MBC) represents < 1% of breast cancer patients, and limited data exists regarding metastatic MBC. To better characterize this patient subset, we performed a population-based study examining prognostic factors among patients with stage IV MBC. METHODS Patients with stage IV MBC diagnosed between 1988 and 2012 were selected from the Surveillance, Epidemiology, and End Results database. Prognostic factors for overall survival (OS) and cause-specific survival (CSS) were evaluated. RESULTS Overall, 394 patients had metastatic disease meeting inclusion criteria. The median follow-up was 21 months. The 5-year OS and CSS rates were 21.1% and 38.3%, respectively. Of those with known progesterone receptor (PR) status, 52% were PR-positive, which was associated with better OS (P < .001) and CSS (P = .003). Overall, 197 patients (50%) received surgery for the primary tumor, and 197 (50%) did not. Patients undergoing surgery had longer median CSS than those who did not (36 vs. 21 months; P < .001). Additional factors that correlated with prolonged OS and CSS were smaller tumor size (≤ 2 cm; P < .05) and younger age (≤ 65 years; P < .05). In multivariate analysis, smaller tumor size, PR-positivity, younger age, and resection of the primary tumor were associated with longer OS and CSS (P < .05). CONCLUSIONS Although stage IV MBC has poor OS and CSS, patients with PR-positive disease, younger age (≤ 65 years), tumor size ≤ 2 cm, or who undergo surgery of the primary tumor have better OS and CSS. This is the largest study of stage IV MBC to date, and these findings address some of the questions regarding this rare presentation of breast cancer.
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Affiliation(s)
- Wei Chen
- Department of General Surgery, Guangdong General Hospital, Guangzhou, China; Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | - Ying Huang
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Gary D Lewis
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX; Department of Radiation Oncology, University of Texas Medical Branch Galveston, Galveston, TX
| | - Sean S Szeja
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX; Department of Radiation Oncology, University of Texas Medical Branch Galveston, Galveston, TX
| | - Sandra S Hatch
- Department of Radiation Oncology, University of Texas Medical Branch Galveston, Galveston, TX
| | - Andrew Farach
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | - Darlene Miltenburg
- Department of Surgery, Texas Women's Comprehensive Breast Center, Houston, TX
| | - E Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX
| | - Jenny C Chang
- Department of Medicine, Houston Methodist Hospital, Houston, TX
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX.
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Farach-Carson MC, Lin SH, Nalty T, Satcher RL. Sex Differences and Bone Metastases of Breast, Lung, and Prostate Cancers: Do Bone Homing Cancers Favor Feminized Bone Marrow? Front Oncol 2017; 7:163. [PMID: 28824875 PMCID: PMC5545941 DOI: 10.3389/fonc.2017.00163] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/19/2017] [Indexed: 12/18/2022] Open
Abstract
Sex-associated differences in bone metastasis formation from breast, lung, and prostate cancer exist in clinical studies, but have not been systematically reviewed. Differences in the bone marrow niche can be attributed to sexual dimorphism, to genetic variations that affect sex hormone levels, or to the direct effects of sex hormones, natural or exogenously delivered. This review describes the present understanding of sex-associated and sex hormone level differences in the marrow niche and in formation of bone metastasis during the transition of these three cancers from treatable disease to an often untreatable, lethal metastatic one. Our purpose is to provide insight into some underlying molecular mechanisms for hormonal influence in bone metastasis formation, and to the potential influence of sexual dimorphism, genetic differences affecting sex assignment, and sex hormone level differences on the bone niche and its favorability for metastasis formation. We reviewed publications in PubMed and EMBASE, including full length manuscripts, case reports, and clinical studies of relevance to our topic. We focused on bone metastasis formation in breast, lung, and prostate cancer because all three commonly present with bone metastases. Several clear observations emerged. For breast cancer bone metastasis formation, estrogen receptor (ER) signaling pathways indicate a role for ER beta (ERβ). Estrogen influences the bone microenvironment, creating and conditioning a favorable niche for colonization and breast cancer progression. For lung cancer, studies support the hypothesis that females have a more favorable bone microenvironment for metastasis formation. For prostate cancer, a decrease in the relative androgen to estrogen balance or a “feminization” of bone marrow favors bone metastasis formation, with a potentially important role for ERβ that may be similar to that in breast cancer. Long-term estrogen administration or androgen blockade in males may feminize the bone marrow niche to one more favorable for bone metastases in prostate cancer. Administration of androgens in females, especially combined with mastectomy, may reduce risk of developing bone metastatic breast cancer. We conclude that it should be considered that females, those with female-leaning genetic variations, or hormonal states that feminize the bone marrow, may offer favorable sites for bone metastases.
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Affiliation(s)
- Mary C Farach-Carson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sue-Hwa Lin
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Theresa Nalty
- Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert L Satcher
- Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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20
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Wu SG, Zhang WW, Liao XL, Sun JY, Li FY, Su JJ, He ZY. Men and women show similar survival outcome in stage IV breast cancer. Breast 2017; 34:115-121. [DOI: 10.1016/j.breast.2017.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 12/23/2022] Open
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21
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Oliveira LLD, Aguiar SSD, Bender PFM, Bergmann A, Thuler LCS. Men Have a Higher Incidence of Seroma after Breast Cancer
Surgery. Asian Pac J Cancer Prev 2017; 18:1423-1427. [PMID: 28612597 PMCID: PMC5555557 DOI: 10.22034/apjcp.2017.18.5.1423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background and Objectives: Male breast cancer (MBC) is rare. While surgical treatment may result in several complications in women, little is known about how it affects men. The objective of this study was to compare the incidence of postoperative wound complications between men and women after breast cancer surgery. Methods: This cohort study included all male patients enrolled for breast cancer surgical treatment at the Brazilian National Cancer Institute, between 1999 and 2013. Each was matched with three female breast cancer patients. Parameters analyzed were necrosis, seroma and infection. Odds ratios (OR) were generated and statistical significance was considered at p<0.05. Results: We included in this study 71 men and 213 women with an average age of 63.5 (±12.0). The incidences of complications in men and women were: necrosis, 32.8% and 37.8% (p=0.477); seroma, 80.6% and 59.4% (p=0.003); and surgical site infection, 14.8% and 18.2% (p=0.54). After adjustment, men had a 3 times greater risk of developing seroma compared to women (OR=3.0; IC95%=1.4-6.4; p=0.004). No statistically significant differences was detected in the incidences of wound infection and necrosis. Conclusion: Men have a greater risk of developing seroma after surgery for breast cancer than women, whereas infection and necrosis occur at similar frequencies in both genders.
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22
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Bender PFM, de Oliveira LL, Costa CR, de Aguiar SS, Bergmann A, Thuler LCS. Men and women show similar survival rates after breast cancer. J Cancer Res Clin Oncol 2016; 143:563-571. [PMID: 27933394 DOI: 10.1007/s00432-016-2311-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/23/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the disease-free survival (DFS) and overall survival (OS) rates of men and women undergoing treatment for breast cancer. METHODS A retrospective cohort study of patients with breast cancer diagnosed and treated at the Cancer Hospital III of the National Cancer Institute of Brazil, Rio de Janeiro, Brazil, between 1999 and 2013. Male breast cancer cases were matched for age, year of diagnosis, and clinical staging to three female cases (1:3). Patient characteristics were abstracted from hospital records and medical charts. Cases were analyzed using descriptive statistics, and comparisons between the genders were performed using Kaplan-Meier curves and Cox regression analysis with 95% confidence intervals. RESULTS The study population comprised 98 men and 294 women. There were significant differences (p < 0.05) between the genders for marital status, alcohol consumption, smoking, presence of hypertension and other comorbidities, histological type of tumor, expression of estrogen receptors, progesterone receptors, human epidermal growth factor receptor-type 2, type of breast surgery, neoadjuvant chemotherapy, adjuvant radiotherapy, and use of palliative bisphosphonate therapy. Five- and 10-year DFS rates were, respectively, 80.0 and 51.4% for men and 71.4 and 63.5% for women (p = 0.245), and 5- and 10-year OS rates were, respectively, 65.0 and 47.5% for men and 56.5 and 41.4% for women (p = 0.221). CONCLUSION There was no significant difference in prognosis (DFS and OS rates) between the genders, but significant differences in sociodemographic and clinical characteristics were detected between male and female breast cancer cases.
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Affiliation(s)
| | | | | | | | - Anke Bergmann
- Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Luiz Claudio Santos Thuler
- Brazilian National Cancer Institute (INCA) and Federal University of Rio de Janeiro State (UNIRIO), Rua André Cavalcanti, 37/2nd floor - Centro, Rio de Janeiro, RJ, 20231-050, Brazil.
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Henriques Abreu M, Henriques Abreu P, Afonso N, Pereira D, Henrique R, Lopes C. Patterns of recurrence and treatment in male breast cancer: A clue to prognosis? Int J Cancer 2016; 139:1715-20. [DOI: 10.1002/ijc.30225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/29/2016] [Accepted: 05/30/2016] [Indexed: 01/16/2023]
Affiliation(s)
- Miguel Henriques Abreu
- Department of Medical Oncology; Portuguese Institute of Oncology of Porto; Porto Portugal
| | - Pedro Henriques Abreu
- Department of Informatics Engineering, Faculty of Sciences and Technology, CISUC; University of Coimbra; Coimbra Portugal
| | - Noémia Afonso
- Department of Medical Oncology; Portuguese Institute of Oncology of Porto; Porto Portugal
| | - Deolinda Pereira
- Department of Medical Oncology; Portuguese Institute of Oncology of Porto; Porto Portugal
| | - Rui Henrique
- Department of Pathology; Portuguese Institute of Oncology of Porto; Porto Portugal
- Department of Pathology and Molecular Immunology; Biomedical Sciences Institute of Abel Salazar, University of Porto; Porto Portugal
| | - Carlos Lopes
- Department of Pathology and Molecular Immunology; Biomedical Sciences Institute of Abel Salazar, University of Porto; Porto Portugal
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Choi MY, Lee SK, Lee JE, Park HS, Lim ST, Jung Y, Ko BK, Nam SJ. Characterization of Korean Male Breast Cancer Using an Online Nationwide Breast-Cancer Database: Matched-Pair Analysis of Patients With Female Breast Cancer. Medicine (Baltimore) 2016; 95:e3299. [PMID: 27100414 PMCID: PMC4845818 DOI: 10.1097/md.0000000000003299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to review the characteristics and the survival rate in male breast cancer (MBC) patients in Korea over a 31-year period. Additionally, we analyzed the overall survival (OS) rate of a group of MBC matched to females with breast cancer. We retrospectively analyzed the data from 400 Korean patients who were treated for MBC from 1978 to 2009. Patient demographics and clinical information were routinely documented throughout the study period. Survival and prognostic factors were evaluated. Each MBC patient was matched with 5 female breast cancer (FBC) patients based on 7 characteristics and we compared the OS rates between the 2 groups. For MBC cases, the median follow-up was 72 months and the 5-year OS rate was 85.9%. In univariate analyses, the prognostic factors influencing OS were age (more than 60 years, P <0.001), tumor size (>2 cm, P = 0.007), and having a negative progesterone receptor (PR) status (P = 0.042). Only the age (P = 0.028) and tumor size (P = 0.024) were significant prognostic factors for OS in multivariate analysis. After matching, we had 260 male patients matched to 1300 female patients for analysis. Compared with cases among females, the rate of mastectomy was higher among MBC cases and tumors, which were almost invasive ductal carcinomas (IDCs), were more likely to be located in the central part of the breast. For MBC cases, the percentage of adjuvant radiation therapy was low compared with female cases. The primary hormone therapy agent used was tamoxifen. The 5-year OS rates were similar in MBC compared with FBC (91.0% vs. 92.6%, P = 0.300). We found that only the age (more than 60 years) and tumor size were independent prognostic factors of survival in MBC. The prognosis for MBC is similar to that for FBC given similar stage and hormone-receptor status.
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Affiliation(s)
- Min-Young Choi
- From the Division of Breast and Endocrine Surgery (M-YC), Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine; Division of Breast and Endocrine Surgery (SKL, JEL, SJN), Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Surgery (HSP), Yonsei University College of Medicine, Seoul; Department of Surgery (STL), St. Vincent's Hospital, The Catholic University of Korea; Department of Surgery (YJ), Ajou University School of Medicine, Suwon; and Department of Surgery (BKK), Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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25
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da Silva TL. Male breast cancer: Medical and psychological management in comparison to female breast cancer. A review. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ctrc.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Teoh ZH, Archampong D, Gate T. Breast cancer in male-to-female (MtF) transgender patients: is hormone receptor negativity a feature? BMJ Case Rep 2015; 2015:bcr-2015-209396. [PMID: 25994431 DOI: 10.1136/bcr-2015-209396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 41-year-old male-to-female (MtF) transgender patient presented with a symptomatic tender lump in the left breast. There was no family history of breast cancer. She had been receiving estrogen therapy for 14 years to maintain her secondary sexual characteristics. Triple assessment revealed a 13 mm triple-negative grade 3 invasive ductal carcinoma. The tumour was completely excised following a left wide local excision and sentinel lymph node biopsy. There was no regional lymph node involvement. She was referred to the oncologist for adjuvant chemotherapy and radiotherapy.
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Affiliation(s)
- Zhi Hao Teoh
- Breast Surgery Unit, Wrexham Maelor Hospital, Wrexham, UK
| | | | - Tim Gate
- Wrexham Maelor Hospital, Wrexham, UK
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Outcome of Male Breast Cancer: A Matched Single-Institution Series. Clin Breast Cancer 2014; 14:371-7. [DOI: 10.1016/j.clbc.2014.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/17/2014] [Accepted: 02/24/2014] [Indexed: 01/06/2023]
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28
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Colebunders B, T'Sjoen G, Weyers S, Monstrey S. Hormonal and Surgical Treatment in Trans‐Women with BRCA1 Mutations: A Controversial Topic. J Sex Med 2014; 11:2496-9. [DOI: 10.1111/jsm.12628] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Johansson I, Killander F, Linderholm B, Hedenfalk I. Molecular profiling of male breast cancer - lost in translation? Int J Biochem Cell Biol 2014; 53:526-35. [PMID: 24842109 DOI: 10.1016/j.biocel.2014.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/07/2014] [Accepted: 05/09/2014] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common cancer form in women and it has been extensively studied on the molecular level. Male breast cancer (MBC), on the other hand, is rare and has not been thoroughly investigated in terms of transcriptional profiles or genomic aberrations. Most of our understanding of MBC has therefore been extrapolated from knowledge of female breast cancer. Although differences in addition to similarities with female breast cancer have been reported, the same prognostic and predictive markers are used to determine optimal management strategies for both men and women diagnosed with breast cancer. This review is focused on prognosis for MBC patients, prognostic and predictive factors and molecular subgrouping; comparisons are made with female breast cancer. Information was collected from relevant literature on both male and female breast cancer from the MEDLINE database between 1992 and 2014. MBC is a heterogeneous disease, and on the molecular level many differences compared to female breast cancer have recently been revealed. Two distinct subgroups of MBC, luminal M1 and luminal M2, have been identified which differ from the well-established intrinsic subtypes of breast cancer in women. These novel subgroups of breast cancer therefore appear unique to MBC. Furthermore, several studies report inferior survival for men diagnosed with breast cancer compared to women. New promising prognostic biomarkers for MBC (e.g. NAT1) deserving further attention are reviewed. Further prospective studies aimed at validating the novel subgroups and recently proposed biomarkers for MBC are warranted to provide the basis for optimal patient management in this era of personalized medicine. This article is part of a Directed Issue entitled: Rare Cancers.
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Affiliation(s)
- Ida Johansson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University Cancer Center, Lund, Sweden; CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Fredrika Killander
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University Cancer Center, Lund, Sweden; Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Barbro Linderholm
- Department of Oncology, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University Cancer Center, Lund, Sweden; CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden.
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Soliman AA, Denewer AT, El-Sadda W, Abdel-Aty AH, Refky B. A retrospective analysis of survival and prognostic factors of male breast cancer from a single center. BMC Cancer 2014; 14:227. [PMID: 24673740 PMCID: PMC3987167 DOI: 10.1186/1471-2407-14-227] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 03/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Less than 1% of all breast cancer cases are found in men, who reportedly have inferior outcomes compared with matched women patients. Ethnic differences may also affect their prognosis. Here, we investigated overall survival (OS) and major prognostic factors for male breast cancer (MBC) in a cohort of Egyptian patients. METHODS We retrospectively analyzed OS in a cohort of 69 male patients with MBC who were surgically treated at the Mansoura Cancer Center, Egypt between 2000 and 2007. We registered demographic data, age, height, weight and body mass index, tumor size, histology, number of infiltrated axillary lymph nodes, hormone receptor (HR) status and metastatic presence, and TNM staging. Patients' OS was the primary endpoint. Patients received treatment to the medical standards at the time of their diagnosis. RESULTS In the 69 patients who met the inclusion criteria and had complete stored patient data, tumors ranged from T1c to T3. We could gather cancer-related survival data from only 56 patients. The collective 5-year survival in this cohort was 46.4%. Only five patients had distant metastasis at diagnosis, but they showed a null percent 5-year survival, whereas those with no lymph node infiltration showed a 100% 5-year survival. Lymph node status and tumor grading were the only prognostic factors that significantly affected OS. CONCLUSIONS Lymph node status and tumor grade are the most important prognostic factors for overall survival of MBC in Egyptian male patients; whereas even remarkably low HR expression in MBC did not significantly affect OS. Further research is needed to understand the factors that affect this disease.
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Affiliation(s)
- Amr A Soliman
- Department of Obstetrics and Gynecology, El-Shatby Maternity University Hospital, University of Alexandria, Port Said Street, El Shatby, Alexandria 21526, Egypt.
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