男性乳腺癌二十一基因复发评分

　　编者按：对于早期雌激素受体阳性HER2阴性乳腺癌女性，21基因复发评分法可以对远处复发风险和辅助化疗获益进行估计，以决定是否进行辅助化疗。由于既往研究数据有限，对于乳腺癌男性的全身治疗，通常根据女性患者研究数据推断。

　　2018年3月8日，美国乳腺外科医师学会和肿瘤外科学会《肿瘤外科学年鉴》在线发表纽约纪念医院斯隆凯特林癌症中心（美国最早、最大的肿瘤医院兼癌症研究机构）的回顾研究报告，对21基因复发评分与男性乳腺癌治疗类型之间的相关性进行了评定。

　　该单中心回顾研究首先确定2006～2016年在该中心接受治疗并有21基因复发评分结果的雌激素受体阳性HER2阴性乳腺癌男性患者共计38例（中位年龄70岁），随后收集其临床病理学特征、治疗和结局的数据。该研究经伦理审查委员会批准。

　　结果发现，肿瘤大小中位1.6cm，淋巴结阴性31例（81.6%）。

　　21基因复发评分：

• 低（≤17分）26例（68.4%）

• 中（18～30）9例（23.7%）

• 高（≥31分）3例（7.9%）

• 分布与该中心女性患者相似

　　所有患者接受全乳房切除术，其中：

• 接受放疗1例（2.6%）

• 激素疗法34例（89.5%）

• 他莫昔芬31例（81.6%）

• 辅助化疗5例（13.2%，21基因复发评分中～高）

• 近处复发0例

• 远处复发1例（中位随访34个月）

　　因此，男性乳腺癌21基因复发评分分布与该机构接受治疗女性相似。可能由于随访时间有限，21基因复发评分低的患者未化疗并且未复发。该研究结果表明，对于男性乳腺癌患者，21基因复发评分可能也有临床意义。

Ann Surg Oncol. 2018 Mar 8. [Epub ahead of print]

The 21-Gene Recurrence Score in Male Breast Cancer.

Turashvili G, Gonzalez-Loperena M, Brogi E, Dickler M, Norton L, Morrow M, Wen HY.

Memorial Sloan Kettering Cancer Center, New York, USA.

BACKGROUND: Given the limited data, systemic treatment of male breast cancer has been extrapolated from female patients. The 21-gene recurrence score (RS) assay estimates the risk of distant recurrence and chemotherapy benefit in early-stage, ER+/HER2- female breast cancer. We assessed the association between RS and type of treatment in male breast cancer.

METHODS: We identified male patients with ER+/HER2- breast cancer and available RS results treated at our institution in 2006-2016. We collected data on clinicopathologic features, treatment, and outcome. The Institutional Review Board approved the study.

RESULTS: The study cohort consists of 38 male breast cancer patients with a median age of 70 years. Median tumor size was 1.6 cm, and 81.6% (31) were node-negative. RS was low (≤ 17) in 26 (68.4%) cases, intermediate (18-30) in 9 (23.7%) cases, and high (≥ 31) in 3 (7.9%) cases, comparable to that in female patients at our institution. All patients underwent total mastectomy, and one received radiotherapy. Thirty-four (89.5%) patients received adjuvant endocrine therapy, mostly tamoxifen (81.6%; 31). Five (13.2%) patients with intermediate or high RS were treated with adjuvant chemotherapy. No locoregional recurrence was observed, and one patient developed distant recurrence (median follow-up 34 months).

CONCLUSIONS: The RS distribution in male breast cancers was similar to that in females treated at our institution. With limited follow-up, patients with low RS were spared chemotherapy and did not develop recurrence. Our results suggest that the RS may have a clinical utility in male breast cancer patients.

PMID: 29520654

DOI: 10.1245/s10434-018-6411-z