August 4, 2006 -- 一項新研究認為男性乳癌和女性乳癌間的病理學、表徵和存活等極為不同。
主要作者、辛辛那提大學的Zeina Nahleh醫師，在美國臨床腫瘤學會42屆年會中發表壁報時表示，男性乳癌病患在疾病早期和結節陰性腫瘤方面之存活較差，性別差異造成腫瘤病理和生物方面之不同；荷薾蒙受體陽性之男性乳癌病患存活也較差，儘管用了相似的荷爾蒙治療方式。
研究者報告指出男性乳癌發生率持續增加，但少有研究提及男性乳癌和女性乳癌間的差異；在2006年四月版的Cancer Treatment Reviews期刊中，Nahleh醫師詳述，男性乳癌罕見而使得對此疾病之了解與治療等探討有限；她指出治療方式多是從女性乳癌治療方式推論而來，而未顧及此兩種疾病間臨床病理特徵之差異，特別是男性荷爾蒙和雌性素的角色。
Nahleh醫師解釋，於男性乳癌和女性乳癌間有關荷薾蒙受體陽性之預後是否相同也尚不清楚；荷爾蒙治療是男性乳癌治療之主軸、以 tamoxifen為第一線藥物；新一代的aromatase抑制劑的角色尚未完全清楚，但臨床實務也用於治療男性乳癌，而這其實是基於女性病患的相關使用資料。
此分析中，研究者使用退伍軍人事務(VA)
癌症登記處之資料而進行一個回溯式分析，比較男性乳癌和女性乳癌間之特徵和結果，共從120個 VA醫學中心回顧3025位病患之資料。
這些病患中有612位男性和2413 位女性乳癌病患，診斷時平均年紀：男性是67歲、女性是57歲 (P < .005)，許多男性乳癌病患是黑人；男性乳癌病患所表現的都是比較後期的疾病、腫瘤較大、且常是結節陽性。
【男性乳癌病患之乳管組織學更常見】
Nahleh醫師和同事也發現男性乳癌病患之乳管組織學更常見，且小葉狀乳癌和乳管內原位癌在女性比較少見，她們也發現雌激素受體(ER)–陽性和黃體素受體 (PR)–陽性腫瘤在男性也顯著較常見 (60% vs 52% 和 53% vs 47%,； P < .005)，研究者報告指出男性乳癌病患較少接受化療，在荷爾蒙治療方面則無統計上之差異。
男性乳癌之平均整體存活較低 (7.0 vs 9.8 年；P < .005)，在第3期和第4期之整體存活無顯著差異，但在第一期(7年 vs 未達；P = .005)和第 2期 (6.0 vs 8.6年； P = .001)較差。
結節陰性腫瘤方面，男性整體存活較差 (6.1 vs 14.6 年；P < .005) ，結節陽性腫瘤方面無統計上之差異；ER- 和 PR-陽性腫瘤方面，男性存活較差(分別是7 vs 8年和 7.3 vs 9.8年；P < .005)；ER- 和 PR-陰性腫瘤方面，無統計上之顯著差異；使用Cox迴歸分析，他們發現年紀、性別、臨床分期和結節狀態是統計獨立預後因素；種族、組織學和等級則不是。
Nahleh和她的團隊結論認為，男性乳癌和女性乳癌間在生物、病理、表徵和存活等方面有差異，且她們提出附加研究以定義男性乳癌病患之其他的合適治療策略。
ASCO 42屆年會：摘要 587。發表於 June 3, 2006。
Male Breast Cancer Very Different From Female Disease
By Allison Gandey
Medscape Medical News
August 4, 2006 — A new study suggests there are important differences in the pathology, presentation, and survival between men and women with breast cancer.
"Survival of male breast-cancer patients appears inferior in early-stage disease and node-negative tumors, suggesting gender differences in the tumor pathogenesis and biology," lead author Zeina Nahleh, MD, from the University of Cincinnati in Ohio, stated during a poster session at the recent 42nd annual meeting of the American Society of Clinical Oncology. "In hormone receptor–positive male breast cancer, survival was also inferior, despite similar hormonal treatment practices."
The researchers report that the incidence of breast cancer in men continues to rise, yet "few studies have addressed the differences between male and female breast cancer." Elaborating in the April 2006 issue of Cancer Treatment Reviews, Dr. Nahleh writes, "The rarity of male breast cancer has precluded major progress in the understanding and treatment of this disease." She points out that treatment has often been extrapolated from female breast cancer despite distinct clinicopathologic features between the 2 diseases, "especially," she notes, "with regard to the role of male hormones and estrogens."
Dr. Nahleh explains that it is also not clear whether hormone receptor–positive tumors carry the same prognostic implication in male breast cancer as in the female disease. "Hormonal therapy has been the mainstay of treatment in male breast cancer, with tamoxifen being the front-line drug. The role of the newer-generation aromatase inhibitors has not been well defined but they are being used in clinical practice for the treatment of male breast cancer based on accepted data for women with the disease."
In this analysis, the researchers used the Veteran Affairs (VA) cancer registry to conduct a retrospective analysis aimed at comparing the characteristics and outcome of male and female breast cancer patients. They looked at a total of 3025 patients from 120 VA medical centers.
The investigators identified 612 male and 2413 female breast cancer patients. Mean age at diagnosis was 67 years for men and 57 years for women (P < .005). More male breast cancer patients were black. They found that male patients presented with a significantly higher stage of disease, had larger tumors, and were more often node-positive.
Ductal Histology More Common in Male Breast Cancer
Dr. Nahleh and colleagues also found that ductal histology was more common in male breast cancer and lobular and ductal carcinoma in situ were less common than in women. They also found that estrogen receptor (ER)–positive and progesterone receptor (PR)–positive tumors were significantly more common in men (60% vs 52% and 53% vs 47%, respectively; P < .005). The researchers report that male breast cancer patients received less chemotherapy but there was no statistical difference in hormonal treatment.
Median overall survival was lower for male breast cancer (7.0 vs 9.8 years; P < .005). Overall survival was not significantly different for stage 3 and 4, but was inferior for stage 1 (7 years vs not reached; P = .005) and stage 2 (6.0 vs 8.6 years, P = .001).
In node-negative tumors, overall survival was inferior for men (6.1 vs 14.6 years; P < .005) but not statistically different for node-positive tumors. In ER- and PR-positive tumors, survival was inferior for men (7 vs 8 years and 7.3 vs 9.8 years, respectively; P < .005). But the researchers observed no statistically significant differences in ER- or PR-negative tumors. Using Cox regression analysis, they found that age, sex, clinical stage, and nodal status were statistically independent prognostic factors; race, histology, and grade were not.
Dr. Nahleh and her team conclude there are differences in the biology, pathology, presentation, and survival between male and female breast cancer patients and they call for additional research to define a different approach and appropriate treatment strategies for men with breast cancer.
ASCO 42nd Annual Meeting: Abstract 587. Presented June 3, 2006.
作者：
Allison Gandey 2007-6-20