Assessment of Prognostic and Therapeutic Factors in Male Breast Cancer: An Observational Study of a Southwest Spanish Single Center

Daniel Herrero; María Rocío  Morales Herrero; José Luis López Guerra; Alberto Sánchez  Camacho-Mejías; Irene Carrasco  García; Paloma Santos  Fernández; Carmen Victoria  Almeida González; Marta Benavent Viñuales; Alejandro Falcón  González; Álvaro Montaño  Periáñez; Rosario González Mancha; Francisco Javier  Salvador Bofill; Manuel Ruiz  Borrego

doi:10.32768/abc.202074155-163

Daniel Herrero ⁽¹⁾, María Rocío Morales Herrero ⁽²⁾, José Luis López Guerra ⁽³⁾, Alberto Sánchez Camacho-Mejías ⁽⁴⁾, Irene Carrasco García ⁽⁵⁾, Paloma Santos Fernández ⁽⁶⁾, Carmen Victoria Almeida González ⁽⁷⁾, Marta Benavent Viñuales ⁽⁸⁾, Alejandro Falcón González ⁽⁹⁾, Álvaro Montaño Periáñez ⁽¹⁰⁾, Rosario González Mancha ⁽¹¹⁾, Francisco Javier Salvador Bofill ⁽¹²⁾, Manuel Ruiz Borrego ⁽¹³⁾

(1) Department of Medical Oncology, University Hospital Virgen del Rocío, Seville, Spain, Spain,

(2) Department of Medical Oncology, University Hospital Virgen del Rocío, Seville, Spain, Spain,

(3) Department of Radiation Oncology, University Hospital Virgen del Rocío, Seville, Spain AND Instituto de Biomedicina de Sevilla (IBIS/HUVR/CSIC/Universidad de Sevilla), Seville, Spain, Spain,

(4) Department of Medical Oncology, University Hospital Virgen del Rocío, Seville, Spain, Spain,

(5) Department of Medical Oncology, University Hospital Virgen del Rocío, Seville, Spain, Spain,

(6) Department of Medical Oncology, University Hospital Virgen del Rocío, Seville, Spain, Spain,

(7) Statistics and Research Methodology Unit University Hospital Virgen del Rocío, Seville, Spain, Spain,

(8) Department of Medical Oncology, University Hospital Virgen del Rocío, Seville, Spain AND Instituto de Biomedicina de Sevilla (IBIS/HUVR/CSIC/Universidad de Sevilla), Seville, Spain., Spain,

(9) Department of Medical Oncology, University Hospital Virgen del Rocío, Seville, Spain, Spain,

(10) , Spain,

(11) , Spain,

(12) Department of Medical Oncology, University Hospital Virgen del Rocío, Seville, Spain AND Instituto de Biomedicina de Sevilla (IBIS/HUVR/CSIC/Universidad de Sevilla), Seville, Spain., Spain,

(13) Department of Medical Oncology, University Hospital Virgen del Rocío, Seville, Spain AND Instituto de Biomedicina de Sevilla (IBIS/HUVR/CSIC/Universidad de Sevilla), Seville, Spain., Spain

https://doi.org/10.32768/abc.202074155-163

Issue
Vol 7, No 4: November 2020

Submitted
August 26, 2020

Published
November 16, 2020

Keywords:

Breast Cancer, BRCA, Endocrine therapy, Male breast cancer, Prognosis

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Abstract

Background: Male breast cancer (MBC) accounts for less than 1% of breast cancer, requiring extrapolation of results from studies in women. The aim of the study is to evaluate prognostic and therapeutic factors with special focus in endocrine treatment (ET) on the disease outcome.
Methods: Observational, retrospective, single-center study of 53 MBC treated between January 1997 and December 2018 participated in the study. Among the participants, 48 patients had a performance status (PS) 0-1 (91%), 48 were hormone-receptor-positive (91%) and 4 were human epidermal growth factor 2 receptor (HER2) positive (8%). A total of 45 patients (85%) were treated with ET, with 36 patients (68%) receiving treatment in an adjuvant setting. The association analysis was performed using Chi-square test and survival was estimated using Kaplan-Meier with SPSS v25.
Results: The cohort had a median age of 68 years old (range: 40-88). We found that 84% had a non-metastatic breast cancer. A breast cancer gene (BRCA) analysis was carried out in 43% of the patients, showing BRCA2 mutated in 26.1% of those analyzed, without obtaining a benefit in overall survival (P=0.698). The analysis showed higher 5-year overall survival (OS) for PS 0 (P=0.010), absence of vascular invasion (P=0.033), Ki67 ?14% (P=0.041) and absence of metastasis at diagnosis (p<0.0001). Patients receiving adjuvant ET above 5 years had a longer median OS (89 vs 69.6 months, P=0.024), disease-free survival (DFS), and distant relapse (84 vs 48 months; P=0.005, and P=0.002, respectively).
Conclusions: Several prognostic factors for male breast cancer have been described. Noteworthy, patients receiving adjuvant ET above 5 years had a higher OS and DFS. BRCA did not show prognostic value in OS in this cohort. Further studies with larger sample size are necessary.

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References

White J, Kearins O, Dodwell D, Horgan K, Hanby AM, et al. Male breast carcinoma: increased awareness needed. Breast Cancer Research. 2011;13(5):219.

Society AC. Cancer Facts & Figs (2018) Atlanta: American Cancer Society. 2018.

Institute NC. Surveillance, Epidemiology, and End Results Program SEER Cancer Statistics Review, 1975–2011. 2011.

Miao H, Verkooijen HM, Chia K-S, Bouchardy C, Pukkala E, et al. Incidence and Outcome of Male Breast Cancer: An International Population-Based Study. Journal of Clinical Oncology. 2011;29(33):4381-6.

André S, Pereira T, Silva F, Machado P, Vaz F, et al. Male breast cancer: Specific biological characteristics and survival in a Portuguese cohort. Mol Clin Oncol. 2019;10(6):644-54.

Estadística INd. Tasas estandarizadas de mortalidad por causa de muerte (causas más frecuentes), sexo y nivel de estudio.

Brinton LA, Richesson DA, Gierach GL, Lacey JV, Jr., Park Y, et al. Prospective evaluation of risk factors for male breast cancer. J Natl Cancer Inst. 2008;100(20):1477-81.

Tai YC, Domchek S, Parmigiani G, Chen S. Breast Cancer Risk Among Male BRCA1 and BRCA2 Mutation Carriers. JNCI: Journal of the National Cancer Institute. 2007;99(23):1811-4.

Rudlowski C. Male Breast Cancer. Breast Care. 2008;3(3):183-9.

Leon-Ferre RA, Giridhar KV, Hieken TJ, Mutter RW, Couch FJ, et al. A contemporary review of male breast cancer: current evidence and unanswered questions. Cancer and Metastasis Reviews. 2018;37(4):599-614.

Giuliano AE, Edge SB, Hortobagyi GN. Eighth Edition of the AJCC Cancer Staging Manual: Breast Cancer. Annals of Surgical Oncology. 2018;25(7):1783-5.

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649-55.

Nicolini A, Ferrari P, Duffy MJ. Prognostic and predictive biomarkers in breast cancer: Past, present and future. Seminars in Cancer Biology. 2018;52:56-73.

Padron-Monedero A, Koru-Sengul T, Tannenbaum SL, Miao F, Hansra D, et al. Smoking and survival in male breast cancer patients. Breast Cancer Research and Treatment. 2015;153(3):679-87.

Reiner AS, Navi BB, DeAngelis LM, Panageas KS. Increased risk of arterial thromboembolism in older men with breast cancer. Breast cancer research and treatment. 2017;166(3):903-10.

Bradshaw PT, Stevens J, Khankari N, Teitelbaum SL, Neugut AI, et al. Cardiovascular Disease Mortality Among Breast Cancer Survivors. Epidemiology. 2016;27(1):6-13.

Nitz U, Gluz O, Christgen M, Kates R, Clemens M, et al. Reducing chemotherapy use in clinically high-risk, genomically low-risk pN0 and pN1 early breast cancer patients: five-year data from the prospective, randomised phase 3 West German Study Group (WSG) PlanB trial. Breast cancer research and treatment. 2017;165.

Fentiman IS. Male breast cancer is not congruent with the female disease. Critical Reviews in Oncology/Hematology. 2016;101:119-24.

Cardoso F, Bartlett JMS, Slaets L, van Deurzen CHM, van Leeuwen-Stok E, et al. Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Annals of Oncology. 2017;29(2):405-17.

Greif JM, Pezzi CM, Klimberg VS, Bailey L, Zuraek M. Gender Differences in Breast Cancer: Analysis of 13,000 Breast Cancers in Men from the National Cancer Data Base. Annals of Surgical Oncology. 2012;19(10):3199-204.

Anderson WF, Althuis MD, Brinton LA, Devesa SS. Is Male Breast Cancer Similar or Different than Female Breast Cancer? Breast Cancer Research and Treatment. 2004;83(1):77-86.

Couch FJ, Farid LM, DeShano ML, Tavtigian SV, Calzone K, et al. BRCA2 germline mutations in male breast cancer cases and breast cancer families. Nature Genetics. 1996;13(1):123-5.

Deb S, Jene N, Kconfab I, Fox SB. Genotypic and phenotypic analysis of familial male breast cancer shows under representation of the HER2 and basal subtypes in BRCA-associated carcinomas. BMC Cancer. 2012;12:510-.

Diez O, Cortés J, Domènech M, Pericay C, Brunet J, et al. BRCA2 germ-line mutations in Spanish male breast cancer patients. Annals of Oncology. 2000;11(1):81-4.

Cloyd JM, Hernandez-Boussard T, Wapnir IL. Outcomes of Partial Mastectomy in Male Breast Cancer Patients: Analysis of SEER, 1983–2009. Annals of Surgical Oncology. 2013;20(5):1545-50.

Hershman DL, Buono D, Jacobson JS, McBride RB, Tsai WY, et al. Surgeon characteristics and use of breast conservation surgery in women with early stage breast cancer. Ann Surg. 2009;249(5):828-33.

Zaenger D, Rabatic BM, Dasher B, Mourad WF. Is Breast Conserving Therapy a Safe Modality for Early-Stage Male Breast Cancer? Clinical Breast Cancer. 2016;16(2):101-4.

Fogh S, Hirsch AE, Goldberg SI, Rosenberg CL, Taghian AG, et al. Use of Tamoxifen With Postsurgical Irradiation May Improve Survival in Estrogen and Progesterone Receptor– Positive Male Breast Cancer. Clinical Breast Cancer. 2011;11(1):39-45.

Eggemann H, Ignatov A, Smith BJ, Altmann U, von Minckwitz G, et al. Adjuvant therapy with tamoxifen compared to aromatase inhibitors for 257 male breast cancer patients. Breast Cancer Research and Treatment. 2013;137(2):465-70.

Reinisch M, Seiler S, Hauzenberger T, Schmatloch S, Strittmatter H-J, et al. 273PD_PRFinal analysis of the Male-GBG54 study: A prospective, randomised multi-centre phase II study evaluating endocrine treatment with either tamoxifen +/- gonadotropin releasing hormone analogue (GnRHa) or an aromatase inhibitor + GnRHa in male breast cancer patients. Annals of Oncology. 2018;29(suppl_8).

Xu S, Yang Y, Tao W, Song Y, Chen Y, et al. Tamoxifen adherence and its relationship to mortality in 116 men with breast cancer. Breast Cancer Research and Treatment. 2012;136(2): 495-502.