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

  • Sarah B. Bateni
  • Anders J. Davidson
  • Mili Arora
  • Megan E. Daly
  • Susan L. Stewart
  • Richard J. Bold
  • Robert J. Canter
  • Candice A. M. SauderEmail author
Breast Oncology

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.

Notes

Funding

The National Center for Advancing Translational Sciences, NIH (UL1TR001860) and the Agency for Healthcare Research and Quality (T32HS022236).

DISCLOSURE

None.

Supplementary material

10434_2019_7159_MOESM1_ESM.docx (157 kb)
Supplementary material 1 (DOCX 156 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Sarah B. Bateni
    • 1
  • Anders J. Davidson
    • 1
  • Mili Arora
    • 2
  • Megan E. Daly
    • 3
  • Susan L. Stewart
    • 4
  • Richard J. Bold
    • 1
    • 5
  • Robert J. Canter
    • 1
    • 5
  • Candice A. M. Sauder
    • 1
    • 5
    Email author
  1. 1.Department of SurgeryUniversity of California, Davis Medical CenterSacramentoUSA
  2. 2.Division of Hematology and Oncology, Department of Internal MedicineUniversity of California, Davis Medical CenterSacramentoUSA
  3. 3.Department of Radiation OncologyUniversity of California, Davis Medical CenterSacramentoUSA
  4. 4.Division of Biostatistics, Department of Public Health SciencesUniversity of California, DavisSacramentoUSA
  5. 5.Division of Surgical OncologyUC Davis Comprehensive Cancer CenterSacramentoUSA

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