Clinicopathological and Immunohistochemical Characteristics in Male Breast Cancer: A Retrospective Case Series.

Abstract

BACKGROUND:

Due to its rarity, male breast cancer (mBC) remains an inadequately characterized disease, and current evidence for treatment derives from female breast cancer (FBC).

METHODS:

We retrospectively analyzed the clinicopathological characteristics, treatment patterns, and outcomes of mBCs treated from 2000 to 2013.

RESULTS:

From a total of 97 patients with mBC, 6 (6.2%) with ductal in situ carcinoma were excluded, and 91 patients with invasive carcinoma were analyzed. Median age was 65 years (range: 25-87 years). Estrogen receptors were positive in 88 patients (96.7%), and progesterone receptors were positive in 84 patients (92.3%). HER-2 was overexpressed in 13 of 85 patients (16%). Median follow-up was 51.5 months (range: 0.5-219.3 months). Five-year progression-free survival (PFS) was 50%, whereas overall survival (OS) was 68.1%. Patients with grades 1 and 2 presented 5-year PFS of 71% versus 22.5% for patients with grade 3 disease; 5-year OS was 85.7% for patients with grades 1 and 2 versus 53.3% of patients with grade 3. Ki-67 score >20% and adjuvant chemotherapy were also statistically significant for OS on univariate analyses. Twenty-six of 87 patients (29.8%) experienced recurrent disease and 16 of 91 patients (17.6%) developed a second neoplasia.

CONCLUSION:

Male breast cancer shows different biological patterns compared with FBC, with higher positive hormone-receptor status and lower HER-2 overexpression. Grade 3 and Ki-67 >20% were associated with shorter OS.

IMPLICATIONS FOR PRACTICE:

There is little evidence that prognostic features established in female breast cancer, such as grading and Ki-67 labeling index, could be applied to male breast cancer as well. This study found that grade 3 was associated with shorter overall survival and a trend for Ki-67 >20%; this could help in choosing the best treatment option in the adjuvant setting. Many questions remain regarding the impact of HER-2 positivity on survival and treatment with adjuvant anti-HER-2 therapy. Regarding metastatic male breast cancer, the results suggest that common regimens of chemo-, endocrine and immunotherapy used in female breast cancer are safe and effective for men. Male breast cancer patients show a higher incidence of second primary tumors, especially prostate and colon cancers and should therefore be carefully monitored.

• Authors: Giovanna Masci, Michele Caruso, Francesco Caruso, Piermario Salvini, Carlo Carnaghi, Laura Giordano, Vittoria Miserocchi, Agnese Losurdo, Monica Zuradelli, Rosalba Torrisi, Luca Di Tommaso, Corrado Tinterri, Alberto Testori, Carlos A Garcia-Etienne, Wolfgang Gatzemeier, Armando Santoro
• Journal: The oncologist (Oncologist) Vol. 20 Issue 6 Pg. 586-92 (Jun 2015) ISSN: 1549-490X [Electronic] England
• PMID: 25948676 (Publication Type: Journal Article)
• Copyright: ©AlphaMed Press.

Chemical References

• Receptors, Estrogen
• Receptors, Progesterone
• ERBB2 protein, human
• Receptor, ErbB-2

Topics

• Adult
• Aged
• Aged, 80 and over
• Breast Neoplasms, Male (classification, drug therapy, genetics, pathology)
• Carcinoma, Ductal, Breast (drug therapy, genetics, pathology)
• Carcinoma, Intraductal, Noninfiltrating (drug therapy, genetics, pathology)
• Disease-Free Survival
• Female
• Gene Expression Regulation, Neoplastic
• Humans
• Male
• Middle Aged
• Neoplasms, Second Primary (drug therapy, genetics, pathology)
• Prognosis
• Receptor, ErbB-2 (biosynthesis, genetics)
• Receptors, Estrogen (genetics)
• Receptors, Progesterone (genetics)
• Retrospective Studies