男性乳腺癌25例的临床病理特征及生存分析

目的分析男性乳腺癌患者的临床病理特征、治疗及生存情况。方法回顾性分析北京大学肿瘤医院乳腺肿瘤内科及北京大学第鼍医院收治的25例男性乳腺癌的临床及随访资料。采用Kaplan．Meier模型分析男性乳腺癌生存情况。结果分析的25例男性乳腺癌发病中位年龄为65岁（44—80岁）。病理类型多为浸润性导管癌（80．0％），仅l例患者为浸润性小叶癌（4．0％）。激素受体阳性患者23例（92．O％）。luminalA—like亚型12例（48．0％），Her-2阴性luminalB—like亚型2例（8．0％），Her-2阳性luminal B—like亚型6例（24．0％），无HER-2过表达型，basal—like型（i阴型）2例（8．0％），未分型3例（12．O％）。早期（I～Ⅲ期）患者比例较大，占92％（23例），均进行了根治性手术治疗，9例（39．1％）接受了辅助化疗，14例（60．9％）接受了辅助内分泌治疗，其中7例患者为他莫昔芬治疗，4例患者为芳香化酶抑制剂（aronlatase inhibitors，AI）联合戈舍瑞林治疗，3例患者为他莫昔芬治疗2～3年转换为AI联合戈舍瑞林治疗。早期乳腺癌患者的5年无病生存率为81％。结论男性乳腺癌是一种少见的疾病，以老年患者为主。早期患者治疗以手术为主，内分泌治疗原则不能完全相同于绝经后的女性乳腺癌，使用AI治疗的患者，应注意下丘脑-垂体-睾丸轴的功能抑制。

Clinicopathological features and survival analysis of 25 male breast cancer patients

Objective To analyze the clinicopathological features, therapy and survival of male breast cancer （MBC） patients. Method Medical records and follow-up information of 25 histopathologieally confirmed MBC who were treated in Breast Cancer Department of Peking University Cancer Hospital and Peking University Third Hospital were retro-spectively reviewed. The Kaplan-Meier model was used to evaluate the prognostic factors for MBC. Result The median age of those 25 breast cancer cases in men is 65 years （44-80 years ）. Most of the pathological types were invasive ductal carcinoma （80. 0%）, only one case was defined as invasive lobular carcinoma （4. 0%）, while 23 cases （92. 0%） were hormone-receptor-positive, and 12 （48.0%） were luminal A-like subtype, 2 （8.0%） were luminal B-like Her-2 negtive subtype, 6 （24. 0%） were luminal B-like Her-2 positive subtype, there was no Her-2-positive （non-luminal） subtype, while 2 （ 8.0% ） were basal-like subtype. Early stage （ I - III stage） accounted for a large proportion of 92% （23 cases）, all of which were administered radical surgery, 9 （39.1%） received adjuvant chemotherapy, 14 （60. 9%） received adjuvant endocrine therapy, of which 7 were treated by tamoxifen, 4 by aromatase inhibitors （AI） combined with goserelin, 3 cases converted to AI combined with goserelin therapy after 2-3 years treatment of tamoxifen. 5-year diseasefree survival rate of early breast cancer was 81%. Conclusion MBC is a rare disease that mainly develops in elderly patients, and surgery is the primary procedure that is applied in treating early stage patients, furthermore, the endocrine therapy principle is not exactly the same as that in postmenopausal women with breast cancer, as patients treated with AI therapy whose function suppression of the hypothalamus-pituitary-testicular axis should be considered.