【原】同为乳腺癌患者，男女各有不同

　　编者按：男性乳腺癌约占所有乳腺癌新病例的1%，其分子生物学特征、治疗与结局的数据非常有限，人们对其了解主要来自乳腺癌女性的数据推断。美国旧金山基因组健康公司研发的乳腺癌21基因表达检测，可以根据21个乳腺癌相关基因（5个增殖相关基因、2个浸润相关基因、2个HER2相关基因、4个雌激素受体相关基因、3个独立基因、5个参考基因）表达情况，对雌激素受体阳性早期乳腺癌治疗后的复发风险进行评分，但是该复发评分结果对于男性乳腺癌的临床意义尚不明确。

　　2018年3月27日，美国临床肿瘤学会《临床肿瘤学杂志》在线发表美国国家癌症研究所、斯坦福大学医学院、斯坦福癌症研究所、旧金山基因组健康公司的研究报告，分析了男性乳腺癌的分子生物学特征和死亡率。

　　该研究于2004年6月～2017年1月通过乳腺癌21基因表达检测，对北美地区激素受体阳性且HER2阴性且淋巴结0～3期乳腺浸润癌男性（3806例）与女性（57万1115例）患者的21基因乳腺癌复发评分结果及其分布、临床特征、5年乳腺癌相关生存和总生存进行了比较分析。

　　结果发现，男性与女性患者相比：

• 平均年龄：64.2比59.1岁（P<0.001）

• 复发评分≥31：12.4%比7.4%（P<0.001）

• 复发评分<18都占多数

• 复发评分<11：33.8%比22.1%（P<0.001）

• 雌激素受体、增殖、浸润相关基因表达率较高

　　年龄<50岁与≥50岁女性相比，雌激素受体表达率较低、孕激素受体表达率较高，随着年龄增长，雌激素受体表达率逐渐增加、孕激素受体表达率逐渐减少。年龄<50岁与≥50岁男性相比，雌激素受体和孕激素受体表达率略低。

　　根据美国国家癌症研究所的监测、流行病学与最终结果（SEER）数据库，获得其中322例男性和5万5842例女性的生存数据。男性与女性相比，5年乳腺癌相关生存率和总生存率较低。5年乳腺癌相关生存率：

• 复发评分<18的男性：99.0%（95%置信区间：99.3%～99.9%）

• 复发评分<18的女性：99.5%（95%置信区间：99.4%～99.6%）

• 复发评分18～30的男性：95.9%（95%置信区间：87.6%～98.7%）

• 复发评分18～30的女性：98.6%（95%置信区间：98.4%～98.8%）

• 复发评分≥31的男性：81.0%（95%置信区间：53.3%～93.2%）

• 复发评分≥31的女性：94.9%（95%置信区间：93.9%～95.7%）

　　因此，该研究揭示了男性乳腺癌的某些独特生物学特征，以及乳腺癌21基因检测复发评分对于男性和女性的重要预后作用。

J Clin Oncol. 2018 Mar 27. [Epub ahead of print]

Molecular Characterization and Mortality From Breast Cancer in Men.

Suleiman Alfred Massarweh, George W. Sledge, Dave P. Miller, Debbie McCullough, Valentina I. Petkov, Steven Shak.

Stanford University School of Medicine and Stanford Cancer Institute, Stanford; Genomic Health, Redwood City, CA; National Cancer Institute, Bethesda, MD.

PURPOSE: Limited data exist on the molecular biology, treatment, and outcomes of breast cancer in men, and much of our understanding in this area remains largely an extrapolation from data in women with breast cancer.

MATERIALS AND METHODS: We studied men and women with hormone receptor-positive breast cancer and the 21-gene Breast Recurrence Score (RS) results. Differences in clinical characteristics and gene expression were determined, and distribution of RS results was correlated with 5-year breast cancer-specific survival (BCSS) and overall survival.

RESULTS: There were 3,806 men and 571,115 women. Men were older than women (mean age, 64.2 v 59.1 years; P < .001). RS < 18 predominated in both genders, but RS ≥ 31 was more frequent in men (12.4% v 7.4%; P < .001), as were very low scores (RS < 11; 33.8% v 22.1%; P < .001). Mean gene expression was higher in men for the estrogen receptor (ER), proliferation, and invasion groups. ER was lowest and progesterone receptor was highest in women younger than 50 years of age, with a progressive increase in ER with age. Men younger than 50 years of age had slightly lower ER and progesterone receptor compared with older men. Survival data were available from SEER for 322 men and 55,842 women. Five-year BCSS was 99.0% (95% CI, 99.3% to 99.9%) and 95.9% (95% CI, 87.6% to 98.7%) for men with RS < 18 and RS 18-30, respectively, and for women, it was 99.5% (95% CI, 99.4% to 99.6%) and 98.6% (95% CI, 98.4% to 98.8%), respectively. RS ≥ 31 was associated with an 81.0% 5-year BCSS in men (95% CI, 53.3% to 93.2%) and 94.9% 5-year BCSS (95% CI, 93.9% to 95.7%) in women. Five-year BCSS and overall survival were lower in men than in women.

CONCLUSION: This study reveals some distinctive biologic features of breast cancer in men and an important prognostic role for RS testing in both men and women.

PMID: 29584547

DOI: 10.1200/JCO.2017.76.8861