Matched-pair analysis of patients with female and male breast cancer: a comparative analysis

<p>Abstract</p> <p>Background</p> <p>Male breast cancer (MBC) is a rare disease accounting for approximately 1% of all breast carcinomas. Presently treatment recommendations are derived from the standards for female breast cancer. However, those approaches might be inadequate because of distinct gender specific differences in tumor biology of breast cancer. This study was planned in order to contrast potential differences between female and male breast cancer in both tumor biological behavior and clinical management.</p> <p>Methods</p> <p>MBC diagnosed between 1995-2007 (region Chemnitz/Zwickau, Saxony, Germany) was retrospectively analyzed. Tumor characteristics, treatment and follow-up of the patients were documented. In order to highlight potential differences each MBC was matched with a female counterpart (FBC) that showed accordance in at least eight tumor characteristics (year of diagnosis, age, tumor stage, nodal status, grade, estrogen- and progesterone receptors, HER2 status).</p> <p>Results</p> <p>108 male/female matched-pairs were available for survival analyses. In our study men and women with breast cancer had similar disease-free (DFS) and overall (OS) survival. The 5-years DFS was 53.4% (95% CI, range 54.1-66.3) in men respectively 62.6% (95% CI, 63.5-75.3) in women (p > 0.05). The 5-years OS was 71.4% (95% CI, 62.1-72.7%) and 70.3% (95% CI, 32.6-49.6) in women (p > 0.05). In males DFS analyses revealed progesterone receptor expression as the only prognostic relevant factor (p = 0.006). In multivariate analyses for OS both advanced tumor size (p = 0.01) and a lack of progesterone receptor expression were correlated (p = 0.01) with poor patients outcome in MBC.</p> <p>Conclusion</p> <p>Our comparative study revealed no survival differences between male and female breast cancer patients and gives evidence that gender is no predictor for survival in breast cancer. This was shown despite of significant gender specific differences in terms of frequency and intensity of systemic therapy in favor to female breast cancer.</p

Abstract P1-01-10: Sentinel lymph node-II biopsy in breast cancer: A novel method to accurately predict non-sentinel axillary lymph node status

Abstract Background: In breast cancer patients, axillary lymph node dissection (ALND) is recommended in the presence of sentinel lymph node metastasis (SLNM). However, in 50-70% of patients, SLN is the only site affected by metastasis and thus majority of these patients are exposed to risk of morbidity of ALND without any benefit. Z011 trial suggests avoiding ALND in early breast cancer patients with isolated SLNM. However, this trial results are not applicable to women with advanced T-stage, multiple SLNM, and the presence of lympho-vascular or peri-capsular invasion. This prospective study aims to analyze whether SLN-II biopsy would help in accurate prediction of non sentinel axillary metastases in the presence of metastatic SLN-I. Methods: After IRB approval, 65 patients with biopsy proven breast cancer underwent SLN biopsy using a standard technique. After identification of the SLN-I, 0.1 cc of methylene blue dye was injected into SLN-I, and the lymphatic channels were traced to identify SLN-II station. ALND was performed in the presence of SLNM. After a pathologic examination, the sensitivity and specificity of SLN-II and the concordance rate between SLN-I, SLN-II and the axilla were calculated to determine the accuracy of SLN-II in identifying the non-sentinel axillary metastasis. Results: A total of 65 breast cancer patients underwent SLN-I and SLN-II biopsy. Average number of SLN-I harvested was 1.7 (range 1-5) and that of SLN-II was 1.4 (range 1-4). Metastases to SLN-I were identified in 12 (18.5%) patients. Upon ALND, only 3 (25%) patients had higher axillary metastasis whereas in 9 patients (75%), axilla had no metastasis. SLN-II predicted the presence (3 of 3) or absence (9 of 9) of axillary metastases with 100% accuracy. The sensitivity, accuracy, false negative rate and negative predictive value of SLN-I in identifying higher axillary metastasis were 92.3%, 98.5%, 7.7% and 98% respectively, whereas same metrics for SLN-II were 100%, 100%, 0% and 100% respectively. Utility of different sentinel lymph node stations in determining axillary metastasesTestTrue positiveTrue negativeFalse negativeSLN-I12521SLN-II4610ALND390 Thus in the presence of SLN-I metastasis, SLN-II accurately identified axillary involvement 100% of the times. One patient was associated with a skip SLN-II metastasis. In this patient SLN-I was negative, however non-sentinel metastases were noted upon ALND. Comparitive analysis of SLN-I and SLN-II in determining axillary metastasisTestSensitivityFNRNPVAccuracyNLRSLN-I12/13 (92.3%)1/13 (7.7%)52/53 (98%)64/65 (98.5%)77%SLN-II4/4 (100%)0%61/61 (100%)65/65 (100%)100%NLR: negative likelihood ratio, NPV, negative predictive value Conclusions: This study demonstrates that in breast cancer patients with SLN-I metastases, SLN-II biopsy is feasible and accurately predicts the higher axillary lymph node status in terms of either the presence or absence of metastasis. In other words, in patients with SLN-I metastasis, a negative SLN-II rules out higher axillary metastasis, whereas the presence of the SLN-II metastasis was associated with further axillary metastasis. Thus, ALND can be avoided in women with isolated SLN-I metastasis but absent SLN-II involvement. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-10.</jats:p