Male Breast Carcinoma: Correlation of ER, PR, Ki-67, Her2-Neu, and p53 with Treatment and Survival, a Study of 65 Cases

Abstract

Male breast cancer is rare, and experience of it in any single institution is limited. Our current understanding regarding its biology, natural history, and treatment strategies has been extrapolated from its female counterpart. The aim of this study is to evaluate the expression patterns of estrogen receptor (ER), progesterone receptor (PR), MiB1 (Ki67), Her-2/neu (c-erbB2), and p53 and to correlate them with the prognosis, presentation, staging, management, and survival/outcome in male breast carcinoma identified through the Veterans Administration nationwide cancer registry. Sixty-five cases of male breast cancer were reviewed for classification. Tumor blocks were requested from each institution for immunohistochemical staining and evaluation of ER, PR, p53, Her2-neu, and MiB1. Seventeen ageand disease-matched male veteran patients with breast gynecomastia were used as controls. Traditional prognostic data were collected for comparison with female breast cancers (i.e., age, lymph node status, clinical staging, tumor size, histological grade, and disease-free and overall survival). Male breast carcinoma had worse disease-free survival than controls (P ‫؍‬ .03). The clinical stage regardless of tumor size or lymph node metastasis was the single most significant prognostic factor (P < .0001). ER-positive patients appeared to have a better survival than did ER-negative patients (P ‫؍‬ .03, univariate; P not significant in multivariate) and did not benefit from treatment with tamoxifen (P ‫؍‬ .0027, univariate; P ‫؍‬ .42, multivariate). MiB1 and PR expressions did not correlate with treatment or survival, and p53 was associated with shorter disease free survival (P ‫؍‬ .07, univariate; P ‫؍‬ .047, multivariate). Stage for stage, Her2-neu was associated with shorter disease-free survival (P < .0001) and correlated with positive lymph nodes (P ‫؍‬ .08). Male breast carcinoma is rare, with an estimated 1,000 to 1,400 new cases per year (1). The tumor phenotypic alterations are not well studied, and experience is mainly inferred from that of female breast cancer. Although both diseases have similarities, there are notable differences in risk factors, prognosis, and survival. Reported differences between male and female breast carcinoma have been noted, and male breast carcinoma has a tendency to present at higher clinical stages and with more lymph node metastases (2-4). Many molecular markers are available for the better understanding of female breast cancer tumorigenesis and disease progression and possibly to guide treatment. How-

CYP3A4 Expression in Breast Cancer and its Association with Risk Factors in Mexican Women

“…As indicated in other studies, positive expressions of ER and PR in breast cancer correlate with better survival and response to estrogen antagonists such as tamoxifen, regardless of tumor size, stage and age (Jacquemier et al, 1998;Shapiro and Recht 2001). ER and PR association has also been reported in male breast carcinoma (Wang-Rodriguez et al, 2002). In this work showed that PR-positive associated with ER-positive tumors appeared to have a better survival but did not offer any differences in disease-free survival.…”

Targeted Therapy in Breast Cancer

“…Despite this apparent heterogeneity of the predominant clone measured by ploidy status, in each metastatic site the HER-2/neu status was consistent between primary tumors and their corresponding metastases (42). HER-2/neu amplification and overexpression has been associated with adverse outcome in some studies of male breast carcinoma (43)(44)(45)(46), but not in others (47)(48)(49)). Finally, low-level HER-2/neu overexpression has been identified in benign breast disease biopsies and associated with an increased risk of subsequent invasive breast cancer (50).…”

Endocrine Therapy for Male Breast Cancer: Rates of Toxicity and Adherence

“…More than 90% of male breast cancer cases are infiltrative ductal carcinomas [1][2][3][4][5] , with 80%-90% expressing the estrogen receptor and 65%-92% expressing the progesterone receptor 3,4,[6][7][8] . Given this receptor profile, endocrine therapy is often prescribed in this patient population.…”