乳腺癌生存结果性别差异与肿瘤亚型的关系

Study of gender differences in breast cancer survival outcomes in relation to tumor subtypes

目的通过对男性乳腺癌和女性乳腺癌病人进行基于人群的最大规模的比较研究,探讨乳腺癌生存结果性别差异与肿瘤亚型的关系。方法利用2010~2012年美国疾病监测、流行病学和最终结果(SEER)项目获得的数据,进行一项基于人群的回顾性队列研究,调查男性和女性在肿瘤亚型、总体生存率(OS)和乳腺癌特异性死亡率(BCSM)的差异。结果181814例乳腺癌病人(男性1516例,女性180298例)符合本研究。男性病人多为黑人,年龄大,组织学分级较低、分期较晚,肿瘤直径较大,淋巴结和远处转移较多,人表皮生长因子受体2(HER2)阴性(P<0.05)。配对分析显示,男性和女性病人的2年OS分别为91.2%和93.7%,BCSM分别为2.2%和2.5%。单因素分析显示,男性三阴性(TN)、激素受体(HoR)阳性/HER2阳性和HoR阳性/HER2阴性病人的OS较差(P<0.01)。同时,HoR阳性/HER2阳性和TN亚型与男性病人的BCSM显著相关(P<0.01)。多因素分析显示,男性TNBC病人的OS和BCSM较差(P<0.05)。同时,结果显示,在调整其他因素后,HoR阳性/HER2阴性亚组中的男性病人死于BC的可能性较小(P<0.05)。结论乳腺癌亚型的2年OS和BCSM分析显示,TN亚型的男性乳腺癌和女性乳腺癌病人有明显的差异。

Objective Exploring the relationship between gender differences in breast cancer survival outcomes and tumor subtypes by conducting the largest population-based comparative study of men with breast cancer and women with breast cancer.Methods A population-based retrospective cohort study using data from the US disease surveillance,epidemiology and final outcomes(Seer)Project 2010-2012,to investigate differences in tumor subtypes,overall survival(OS),and breast cancer-specific mortality(BCSM)between men and women.Results A total of 181814 breast cancer patients(1516 men and 180298 women)met the criteria of this study.The male patients were mostly black people,old,with low histological grade,late stage,large tumor,more lymph node and distant metastasis,and human EGFR 2(HER2)negative tumor(P<0.05).The two-year OS of male and female patients was 91.2%and 93.7%,and that of BCSM was 2.2%and 2.5%,respectively.Univariate analysis showed that the OS of male triple negative(TN),hormone receptor(Hor)/HER2 positive and HOR/HER2 negative patients were worse(P<0.01).At the same time,both HOR/HER2 positive and TN subtype were significantly associated with BCSM in male patients(P<0.01).Multivariate analysis showed that OS and BCSM were worse in patients with TN MBC(P<0.05).At the same time,the results showed that male patients in the HR+/HER2 negative subgroup were less likely to die of BC after adjustment for other factors(P<0.05).Conclusion A 2-year OS and BCSM analysis of breast cancer subtypes showed significant differences between male and female breast cancer patients with TN subtypes,and these differences deserve further study.