Male breast cancer outcomes: validation and modification of a guideline.
Authors: S Shah, LP Middleton, I Bedrosian, SH Giordano, W Yang, T Yu, W Woodward, JL Oh, W Tereffe, EA Strom, TA Buchholz, GH Perkins
Journal: Cancer Research (2009)

Abstract Abstract #4131 Purpose: Previously, we have proposed that male patients be staged, treated, and evaluated for outcomes similar to women with breast cancer. This study examines the outcomes of our recommended guideline.&amp;#x2028; Methods and Materials: 262 patients were registered at our institution between 1944 and 2008 and were reviewed per an IRB approved protocol. Patients having metastatic, recurrent, bilateral, and inflammatory disease were excluded. Radiology and pathology were reviewed. Surgical techniques, systemic therapy utilization, and XRT use were analyzed. Descriptive, Kaplan-Meier, and log-rank statistics were generated.&amp;#x2028; Results: 233 patients were evaluable. Median age was 60 years. Mean follow-up was 95 months. Laterality was equally distributed. 60% had a positive family history. 45% were T1. 52% were clinically node negative. Only 29% underwent any staging-related imaging. Over 80% of the patients whose hormonal status was known were ER +; fewer than 7% of the patients were margin positive. 90% of patients had mastectomy while 7% were managed by conservation. 90% of patients whose systemic therapy recommendation was known received tamoxifen. 65% received no chemotherapy while 23% received doxorubicin -based, 5% received taxanes, and 5% received novel systemic regimens. 39% received radiation therapy and the median dose was 55Gy.&amp;#x2028; The 5 and 10 year OS, DMFS, and LRC for the entire cohort was 72%/47%, 68%/49%, and 87%/81%. OS was significantly improved by smaller tumor size, decreased number of positive nodes, and receipt of adjuvant hormonal therapy ( all p&amp;lt; 0.002),while focal nipple involvement or skin involvement did not significantly affect outcome (all p&amp;gt; 0.15). Interestingly, there was no significant OS benefit with the utilization of chemotherapy (p=.60) although patients receiving novel regimens or regimens with doxorubicin and taxanes had better OS (10% of all patients and NSS). Decreased OS was noted in patients treated with conservation approach as compared to mastectomy (p&amp;lt; 0.0001). The use of radiation therapy did not confer a survival benefit (p= 0.2). LRC : improved with decreased tumor size, less LN+, and hormonal therapy use (all p&amp;lt; 0.0005); was unaffected by nipple involvement, skin involvement, or chemotherapy administration (all p&amp;gt;0.15)); and decreased with use of conservation (p=0.04). DMFS : improved with smaller tumor size, less LN+, and adjuvant hormonal therapy (all p&amp;lt;0.002); was unaffected by nipple involvement, skin involvement, chemotherapy, radiation therapy, and conservation (all p&amp;gt;0.2).&amp;#x2028; Conclusions: Our study confirms our recommended guidelines for MBC;however, the presence of skin and nipple involvement does not appear to predict outcome. Conservation should be utilized in selected patients and XRT emphasized. Chemotherapy was utilized in worse prognosis patients yet OS, and DMFS was equivalent to favorable groups. Modifications should be made to update guidelines for future studies. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4131.