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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2019

01-07-2019 | Mastectomy | Breast Oncology

Is Breast-Conserving Therapy Appropriate for Male Breast Cancer Patients? A National Cancer Database Analysis

Authors: Sarah B. Bateni, MD, Anders J. Davidson, MD, Mili Arora, MD, Megan E. Daly, MD, Susan L. Stewart, PhD, Richard J. Bold, MD, Robert J. Canter, MD, Candice A. M. Sauder, MD

Published in: Annals of Surgical Oncology | Issue 7/2019

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Abstract

Background

Current treatment guidelines for male breast cancer are predominantly guided by female-only clinical trials. With scarce research, it is unclear whether breast-conserving therapy (BCT) is equivalent to mastectomy in men. We sought to compare overall survival (OS) among male breast cancer patients who underwent BCT versus mastectomy.

Methods

We performed a retrospective analysis of 8445 stage I–II (T1–2 N0–1 M0) male breast cancer patients from the National Cancer Database (2004–2014). Patients were grouped according to surgical and radiation therapy (RT). BCT was defined as partial mastectomy followed by RT. Multivariable and inverse probability of treatment-weighted (IPTW) Cox proportional hazards models were used to compare OS between treatment groups, controlling for demographic and clinicopathologic characteristics.

Results

Most patients underwent total mastectomy (61.2%), whereas 18.2% underwent BCT, 12.4% underwent total mastectomy with RT, and 8.2% underwent partial mastectomy alone. In multivariable and IPTW models, partial mastectomy alone, total mastectomy alone, and total mastectomy with RT were associated with worse OS compared with BCT (p < 0.001 all). Ten-year OS was 73.8% for BCT and 56.3, 58.0 and 56.3% for other treatment approaches. Older age, higher T/N stage, histological grade, and triple-negative receptor status were associated with poorer OS (p < 0.05). Subgroup analysis by stage demonstrated similar results.

Conclusions

In this national sample of male breast cancer patients, BCT was associated with greater survival. The underlying mechanisms of this association warrant further study, because more routine adoption of BCT in male breast cancer appears to translate into clinically meaningful improvements in survival.
Appendix
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Metadata
Title
Is Breast-Conserving Therapy Appropriate for Male Breast Cancer Patients? A National Cancer Database Analysis
Authors
Sarah B. Bateni, MD
Anders J. Davidson, MD
Mili Arora, MD
Megan E. Daly, MD
Susan L. Stewart, PhD
Richard J. Bold, MD
Robert J. Canter, MD
Candice A. M. Sauder, MD
Publication date
01-07-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 7/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07159-4

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