男性乳腺癌22例诊治分析

目的探讨男性乳腺癌患者的临床特点、治疗方式、病理类型及预后。方法回顾性分析北京友谊医院1990年1月至2012年12月收治的22例男性乳腺癌患者的临床资料,分析其病理类型及术后生存时间。结果手术方式为15例行乳腺癌改良根治术,5例行乳腺癌根治术;1乳腺区段切除+前哨淋巴结活检(SLNB);1例行乳房单纯切除术。术后病理示20例为浸润性导管癌,1例为浸润性小叶癌,1例为神经内分泌癌;20例患者行激素受体等免疫组化,结果示雌激素受体(ER)(+++)13例,ER(++)5例,ER(+)1例,ER(-)1例;孕激素受体(PR)(+++)10例,PR(++)6例,PR(+)2例,PR(-)2例;人类表皮生长因子受体-2(HER-2)(+++)2例,HER-2(++)3例,HER-2(+)5例,HER-2(-)10例;临床TNMⅠ、Ⅱ期5年生存率明显高于Ⅲ、Ⅳ期,腋窝淋巴结转移者5年生存率明显低于无转移者。ER、PR阳性者及Her-2阴性表达者5年生存率明显高于ER、PR阴性及Her-2阳性表达者;除外1例失访外,其余21例中位随访4年(1～9年),5年生存率为47.6%(10/21)。结论男性乳腺癌为临床罕见病例,病理类型以浸润性导管癌为主,ER、PR阳性及Her-2阴性表达患者5年生存率较高。

Study on diagnosis and treatment of male breast cancer, a report of 22 cases

Objective To explore the clinical characteristics of treatment, histological types and prognosis of breast cancer in male pa- tients. Methods The clinical data of 22 male patients with breast cancer treated in this hospital during January 1990 to December 2012 were ret- rospectively analyzed for pathological types and survival time. Results The surgical procedures for 15 patients were modified radical mastectomy, 5 patients underwent radical mastectomy; 1 patient with sectional resection of breast and sentinel lymph node biopsy（SLNB） ; and 1 patient with breast resection alone. Pathological examination showed that invasive ductal carcinoma in 20 cases, invasive lobular carcinoma in 1 case, and neu- roendocrine carcinoma in 1 case. Immunohistochemi - cal results for hormone receptors in 20 patients of this group demonstrated estrogen receptor （ER） （ ＋ ＋ ＋） in 13 cases, ER （＋ ＋） in5 cases, ER （＋） inlcase, ER （-） inl case; progesterone receptor （PR） （＋ ＋ ＋） in 10 cases, PR （ ＋ ＋ ） in 6 cases, PR （ ＋ ） in 2 cases, PR （ - ） in 2 cases; and human epidermal growth factor receptor-2 （HER -2） （ ＋ ＋ ＋） in2cases, HER-2 （ ＋ ＋） in3cases, HER-2 （＋） in 5 cases and HER - 2 （-） inl0cases. The 5 - year survival rate of patients with clinical TNM I, II stages was significantly higher than that ofpatients with 111 and IV stages, and the 5 - year survival rate in patients with me- tastasis in axillary lymph nodes was significantly lower than those without metastasis. The 5 - year survival rate of patients with ER and PR positive and negative expression of Her - 2 was significantly higher than that of those with ER, PR negative and Her - 2 positive expression in remaining 21 cases ; except 1 patient was lost in a median follow - up of 4 years （ 1 to 9 years）, and their 5 - year survival rate was 47.6% （ 10/21 ）. Conclu- sion Male cases of breast cancer are clinically rare, the main pathological type is invasive ductal carcinoma, and the 5 - year survival rate of pa- tients with ER and PR positive and Her- 2 negative expression is higher.