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Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program

2017; Elsevier BV; Volume: 29; Issue: 2 Linguagem: Inglês

10.1093/annonc/mdx651

1569-8041

Fátima Cardoso, John M.S. Bartlett, Leen Slaets, Carolien H. M. van Deurzen, Elise van Leeuwen-Stok, Peggy L. Porter, Barbro Linderholm, Ingrid Hedenfalk, C.P. Schröder, John W.M. Martens, Jane Bayani, CJ van Asperen, Melissa P. Murray, Clifford A. Hudis, Lavinia P. Middleton, Joanna Vermeij, Kevin Punie, Judith Fraser, Monika Nowaczyk, Isabel T. Rubio, Stefan Aebi, Catherine M. Kelly, Kathryn J. Ruddy, Eric P. Winer, Cecilia Nilsson, Lissandra Dal Lago, Larissa A. Korde, Kim Benstead, Oliver Bögler, Theodora Goulioti, Aleksandra Peric, Saskia Litière, K.C. Aalders, Coralie Poncet, Konstantinos Tryfonidis, Sharon H. Giordano,

BRCA gene mutations in cancer

ABSTRACT Background Male breast cancer (BC) is rare, managed by extrapolation from female BC. The International Male BC Program aims to better characterize and manage this disease. We report the results of part I, a retrospective joint analysis of cases diagnosed during a 20-year period. Methods Patients with follow-up and tumor samples, treated between 1990 and 2010, in 93 centers/9 countries. Samples were centrally analyzed in three laboratories (the United Kingdom, the Netherlands and the United States). Results Of 1822 patients enrolled, 1483 were analyzed; 63.5% were diagnosed between 2001 and 2010, 57 (5.1%) had metastatic disease (M1). Median age at diagnosis: 68.4 years. Of 1054 M0 cases, 56.2% were node-negative (N0) and 48.5% had T1 tumors; 4% had breast conserving surgery (BCS), 18% sentinel lymph-node biopsy; half received adjuvant radiotherapy; 29.8% (neo)adjuvant chemotherapy and 76.8% adjuvant endocrine therapy (ET), mostly tamoxifen (88.4%). Per central pathology, for M0 tumors: 84.8% ductal invasive carcinomas, 51.5% grade 2; 99.3% estrogen receptor (ER)-positive; 81.9% progesterone receptor (PR)-positive; 96.9% androgen receptor (AR)-positive [ER, PR or AR Allred score ≥3]; 61.1% Ki67 expression low (<14% positive cells); using immunohistochemistry (IHC) surrogates, 41.9% were Luminal-A-like, 48.6% Luminal-B-like/HER-2-negative, 8.7% HER-2-positive, 0.3% triple negative. Median follow-up: 8.2 years (0.0–23.8) for all, 7.2 years (0.0–23.2), for M0, 2.6 years (0.0–12.7) for M1 patients. A significant improvement over time was observed in age-corrected BC mortality. BC-specific-mortality was higher for men younger than 50 years. Better overall (OS) and recurrence-free survival (RFS) were observed for highly ER+ ( P = 0.001), highly PR+ ( P = 0.002), highly AR+ disease ( P = 0.019). There was no association between OS/RFS and HER-2 status, Ki67, IHC subtypes nor grade. Conclusions Male BC is usually ER, PR and AR-positive, Luminal B-like/HER2-negative. Of note, 56% patients had T1 tumors but only 4% had BCS. ER was highly positive in >90% of cases but only 77% received adjuvant ET. ER, PR and AR were associated with OS and RFS, whereas grade, Ki67 and IHC surrogates were not. Significant improvement in survival over time was observed.