Impacts of Subtype on Clinical Feature and Outcome of Male Breast Cancer: Multicenter Study in Korea (KCSG BR16-09)

Abstract

Purpose: The treatment of male breast cancer (MBC) has been extrapolated from female breast cancer (FBC) because of its rarity despite their different clinicopathologic characteristics. We aimed to investigate the distribution of intrinsic subtypes based on immunohistochemistry, their clinical impact, and treatment pattern in clinical practice through a multicenter study in Korea.

Materials and methods: We retrospectively analyzed clinical data of 248 MBC patients from 18 institutions across the country from January 1995 to July 2016.

Results: The median age of MBC patients was 63 years (range, 25 to 102 years). Among 148 intrinsic subtype classified patients, 61 (41.2%), 44 (29.7%), 29 (19.5%), and 14 (9.5%) were luminal A, luminal B, human epidermal growth factor receptor 2, and triple-negative breast cancer, respectively. Luminal A subtype showed trends for superior survival compared to other subtypes. Most hormone receptor-positive patients (166 patients, 82.6%) received adjuvant endocrine treatment. Five-year completion of adjuvant endocrine treatment was associated with superior disease-free survival (DFS) in patients classified with an intrinsic subtype (hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.04 to 0.49; p=0.002) and in all patients (HR, 0.16; 95% CI, 0.05 to 0.54; p=0.003).

Conclusion: Distribution of subtypes of MBC was similar to FBC and luminal type A was most common. Overall survival tended to be improved for luminal A subtype, although there was no statistical significance. Completion of adjuvant endocrine treatment was associated with prolonged DFS in intrinsic subtype classified patients. MBC patients tended to receive less treatment. MBC patients should receive standard treatment according to guidelines as FBC patients.

Keywords: Asia; Breast neoplasms; Male; Prognosis; Type.

Fig. 1

Flow diagram of enrolled patients. HER2, human epidermal growth factor receptor 2.

Fig. 2

Survival outcomes in treated patients: (A) in all treated patients, (B) overall survival according to age, and (C) overall survival according to stage. CI, confidence interval; HR, hazard ratio; mOS, median overall survival; NA, not available; OS, overall survival.

Fig. 3

Survival outcomes according to subtypes. (A) Comparison of OS between luminal and non-luminal subtypes. (B) Comparison of OS between luminal A and other subtypes (n=148). CI, confidence interval; HR, hazard ratio; OS, overall survival.

Fig. 4

Survival outcomes according to completion of adjuvant endocrine treatment in hormone receptor–positive subgroup. (A) DFS according to completion of adjuvant endocrine treatment. (B) OS according to completion of adjuvant endocrine treatment. CI, confidence interval; DFS, disease-free survival; HR, hazard ratio; NA, not available; OS, overall survival.