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Article(id=1209139838968795634, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1209139833285505965, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2021.07.15, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1611244800000, receivedDateStr=2021-01-22, revisedDate=1623081600000, revisedDateStr=2021-06-08, acceptedDate=null, acceptedDateStr=null, onlineDate=1766211002341, onlineDateStr=2025-12-20, pubDate=1627401600000, pubDateStr=2021-07-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1766211002341, onlineIssueDateStr=2025-12-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1766211002341, creator=13701087609, updateTime=1766211002341, updator=13701087609, issue=Issue{id=1209139833285505965, tenantId=1146029695717560320, journalId=1189873630562394117, year='2021', volume='46', issue='7', pageStart='637', pageEnd='742', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1766211000986, creator=13701087609, updateTime=1766212174313, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1209144754630168707, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1209139833285505965, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1209144754630168708, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1209139833285505965, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=737, endPage=742, ext={EN=ArticleExt(id=1209139839279174147, articleId=1209139838968795634, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Clinical research progress of male breast cancer and the research status in China, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Male breast cancer (MBC) is a rare disease for which almost no prospective studies have focused on its diagnosis and treatment. MBC is more likely to be positive for hormone receptor while the ratio of triple negative and human epidermal growth factor receptor 2 (HER2) positive is very low. Most men have undergone radical mastectomy and modified radical mastectomy after diagnosis of breast cancer during past decades and sentinel lymph node biopsy has been gradually used in recent years. The indications of postoperative adjuvant radiotherapy refer to female breast cancer (FBC). Tamoxifen is the first choice of adjuvant endocrine therapy for MBC and chemotherapy can also improve MBC patients' prognosis. Anti-HER2 therapy is recommended for patients with high risks, though there is no definite evidence for its application. Data for the use of new drugs in MBC are lacking,whereas it may be a reasonable approach for metastatic MBC. In general, the overall prognosis of MBC is worse than FBC, but a few studies showed that MBC and FBC had similar survival rates after adjustment for demographic characteristics, disease stage, and treatment. Most of published articles are retrospective studies including small cohorts of MBC patients, which have been reviewed in this article. The review summarizes current data on the epidemiology of MBC, pathological and clinical characteristics, prognosis and treatment, and data published in our country during the past decade.

, correspAuthors=Xiang-Yu Wang, authorNote=null, correspAuthorsNote=
*E-mail:
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男性乳腺癌(MBC)是一种少见疾病，大部分为激素受体阳性，三阴性和HER2阳性的比例很低。MBC的治疗主要以根治术和改良根治术为主，前哨淋巴结活检也逐渐得到应用，术后辅助放疗的指征参照女性乳腺癌(FBC)。他莫昔芬是MBC辅助内分泌治疗的首选药物，能够改善预后。虽然抗HER2治疗的应用缺乏明确证据，但建议高危患者应用。新型药物的应用目前尚未见临床证据，但对于晚期患者其为可选方案。MBC总体预后较FBC差，但按照人口特征、分期、治疗方法等进行配对研究显示两者预后相似。MBC相关的前瞻性诊治研究较少，目前已发表的研究多为样本量较小的回顾性研究。该文综述MBC的病理特点、临床表现和诊断方法、治疗及预后等方面的研究进展，并汇总我国近10年来MBC的研究现状。

, correspAuthors=王翔宇, authorNote=null, correspAuthorsNote=
王翔宇，E-mail：
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王子行，主要从事乳腺癌临床特点和预后关系、免疫治疗方面的研究

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王子行，主要从事乳腺癌临床特点和预后关系、免疫治疗方面的研究

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王子行，主要从事乳腺癌临床特点和预后关系、免疫治疗方面的研究

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Clinicopathological features and survival analysis of 114 male breast cancer[J]. 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Clinical-pathologic study of 52 patients with male breast cancer[D]. Zhengzhou: Zhengzhou University, 2018., articleTitle=Clinical-pathologic study of 52 patients with male breast cancer, refAbstract=null), Reference(id=1209139851492987771, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, doi=null, pmid=null, pmcid=null, year=2018, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[53], rfOrder=63, authorNames=孙松, journalName=null, refType=null, unstructuredReference=[孙松. 52例男性乳腺癌的临床病理特征分析[D]. 郑州: 郑州大学, 2018.], articleTitle=52例男性乳腺癌的临床病理特征分析, refAbstract=null), Reference(id=1209139851581068158, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, doi=null, pmid=null, pmcid=null, year=2020, volume=47, issue=2, pageStart=97, pageEnd=101, url=null, language=null, rfNumber=[54], rfOrder=64, authorNames=Mo WJ, Ding XW, Guo ZY, journalName=Cancer Res Prev Treat, refType=null, unstructuredReference=Mo WJ, Ding XW, Guo ZY, et al. Clinicopathological characteristics and outcomes of male patients with resected distant metastasis-free breast cancer in a single center[J]. Cancer Res Prev Treat, 2020, 47(2): 97-101., articleTitle=Clinicopathological characteristics and outcomes of male patients with resected distant metastasis-free breast cancer in a single center, refAbstract=null), Reference(id=1209139851660759935, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, doi=null, pmid=null, pmcid=null, year=2020, volume=47, issue=2, pageStart=97, pageEnd=101, url=null, language=null, rfNumber=[54], rfOrder=65, authorNames=莫文菊, 丁小文, 郭振英, journalName=肿瘤防治研究, refType=null, unstructuredReference=[莫文菊, 丁小文, 郭振英, 等. 单中心非转移性男性乳腺癌临床病理特征和生存分析[J]. 肿瘤防治研究, 2020, 47(2): 97-101.], articleTitle=单中心非转移性男性乳腺癌临床病理特征和生存分析, refAbstract=null), Reference(id=1209139851723674498, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, doi=null, pmid=null, pmcid=null, year=2020, volume=40, issue=5, pageStart=684, pageEnd=687, url=null, language=null, rfNumber=[55], rfOrder=66, authorNames=Qin L, Xing ZY, Liu JQ, journalName=Basic Clin Med, refType=null, unstructuredReference=Qin L, Xing ZY, Liu JQ, et al. Clinical characteristics and genetic etiology of 50 cases of Chinese male breast cancer[J]. Basic Clin Med, 2020, 40(5): 684-687., articleTitle=Clinical characteristics and genetic etiology of 50 cases of Chinese male breast cancer, refAbstract=null), Reference(id=1209139851803366277, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, doi=null, pmid=null, pmcid=null, year=2020, volume=40, issue=5, pageStart=684, pageEnd=687, url=null, language=null, rfNumber=[55], rfOrder=67, authorNames=秦岭, 邢泽宇, 刘嘉琦, journalName=基础医学与临床, refType=null, unstructuredReference=[秦岭, 邢泽宇, 刘嘉琦, 等. 50例中国男性乳腺癌临床特征和遗传学病因[J]. 基础医学与临床, 2020, 40(5): 684-687.], articleTitle=50例中国男性乳腺癌临床特征和遗传学病因, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1209139840000594467, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, xref=1, ext=[AuthorCompanyExt(id=1209139840013177381, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, companyId=1209139840000594467, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1School of Basic Medical Sciences, Jining Medical University, Jining, Shandong 272067, China), AuthorCompanyExt(id=1209139840025760294, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, companyId=1209139840000594467, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1山东省济宁医学院基础医学院，山东济宁 272067)]), AuthorCompany(id=1209139840134812208, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, xref=2, ext=[AuthorCompanyExt(id=1209139840139006513, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, companyId=1209139840134812208, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Cancer Prevention, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China), AuthorCompanyExt(id=1209139840147395121, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, companyId=1209139840134812208, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院防癌体检中心，北京 100021)]), AuthorCompany(id=1209139841305023031, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, xref=3, ext=[AuthorCompanyExt(id=1209139841313411641, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, companyId=1209139841305023031, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China), AuthorCompanyExt(id=1209139841321800249, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, companyId=1209139841305023031, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院乳腺外科，北京 100021)])], figs=[ArticleFig(id=1209139843246985900, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, language=EN, label=Tab.1, caption=

Studies on SLNB in MBC

, figureFileSmall=null, figureFileBig=null, tableContent=
参考文献样本量(n)SLNBSLN检出率(%)SLN阳性率(%)
Boughey et al[21]30IB和Tc10037
Rusby et al[22]31IB和Tc(16例)，IB(5例)，Tc(10例)9055
Gentilini et al[23]32Tc10019
Flynn et al[20]78IB和Tc9749
Kiluk et al[24]34IB和Tc10029
Maraz et al[25]25IB和Tc10048
), ArticleFig(id=1209139843322483377, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, language=CN, label=表1, caption=

男性乳腺癌前哨淋巴结活检研究结果

, figureFileSmall=null, figureFileBig=null, tableContent=
参考文献样本量(n)SLNBSLN检出率(%)SLN阳性率(%)
Boughey et al[21]30IB和Tc10037
Rusby et al[22]31IB和Tc(16例)，IB(5例)，Tc(10例)9055
Gentilini et al[23]32Tc10019
Flynn et al[20]78IB和Tc9749
Kiluk et al[24]34IB和Tc10029
Maraz et al[25]25IB和Tc10048
), ArticleFig(id=1209139843414758070, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, language=EN, label=Tab.2, caption=

Studies on MBCinChina

, figureFileSmall=null, figureFileBig=null, tableContent=
序号参考文献确诊时间样本量(例)分期[例(%)]手术方式[例(%)]辅助治疗[例(%)]随访(月)5年总生存率(%)
0ⅠⅡⅢⅣ根治术改良根治术单纯乳房切除术保乳术前哨淋巴结活检术内分泌治疗化疗放疗中位时间随访时间
1Tan et al[45]1982－200652 21(40.4)17(32.7)9(17.3)5(9.6)15(28.8)23(44.2)9(17.3)  18(34.6)26(50.0)31(59.6)  65.0
2Zhou et al[46]1969－200972 16(22.2)22(30.6)26(36.1)2(2.8)46(63.9)15(20.8)1(1.4)2(2.8) 32(44.4)47(65.3)14(19.4)62.4 72.4
3Zhang et al[47]2001－200962 13(21.0)23(37.1)26(41.9) 22(35.5)11(17.7)2(3.2)  14(22.6)17(27.4)5(8.1) 36
4Wang et al[48]1980－2010102 19(18.6)56(54.9)27(26.5) 62(60.8)26(25.5)7(6.9)7(6.9) 22(21.6)87(85.3)33(32.4)65 72.8
5Qin et al[49]2002－201159 7(11.9)23(39.0)25(42.4)4(6.8)39(66.1)13(22.0)3(5.1)4(6.8) 38(64.4)22(37.3)29(49.2)45 61.0
6Ma et al[50]1994－201358 12(20.7)16(27.6)15(25.9)15(25.9)35(60.3)  3(5.2) 12(20.7)22(37.9)8(13.8) 4~11242.4
7Ye et al[51]1980－2014516(11.8)6(11.8)31(60.8)4(7.8)4(7.8)6(11.8)45(88.2)   32(62.7)28(54.9)13(25.5)60 89.6
8Xu et al[52]2000－2014114 24(21.1)66(57.9)23(20.2)1(0.9)55(48.2)48(42.1)5(4.4)  72(63.2)107(93.9)26(22.8)48 61.9
9Sun et al[53]2002－201852 13(25.0)19(36.5)11(21.2)9(17.3)3(5.8)35(67.3)10(19.2)  21(40.4)24(46.2)17(32.7)46 61.5
10Mo et al[54]1986－20181724(2.3)53(30.8)57(33.1)38(22.1) 71(41.3)71(41.3)7(4.1)3(1.7)19(11.0)145(84.3)92(53.5)99(57.6)42.7 82.4
11Qin et al[55]2015－201950 17(34.0)12(24.0)13(26.0)2(4.0) 32(64.0)11(22.0)3(6.0)13(26.0)42(84.0)26(52.0)10(20.0) 13.3~73.9 
总计  84410(1.2)201(23.8)342(40.5)217(25.7)42(5.0)354(41.9)319(37.8)55(6.5)22(2.6)32(3.8)448(53.1)498(59.0)285(33.8)   
), ArticleFig(id=1209139843519615676, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1209139838968795634, language=CN, label=表2, caption=

我国男性乳腺癌相关研究

, figureFileSmall=null, figureFileBig=null, tableContent=
序号参考文献确诊时间样本量(例)分期[例(%)]手术方式[例(%)]辅助治疗[例(%)]随访(月)5年总生存率(%)
0ⅠⅡⅢⅣ根治术改良根治术单纯乳房切除术保乳术前哨淋巴结活检术内分泌治疗化疗放疗中位时间随访时间
1Tan et al[45]1982－200652 21(40.4)17(32.7)9(17.3)5(9.6)15(28.8)23(44.2)9(17.3)  18(34.6)26(50.0)31(59.6)  65.0
2Zhou et al[46]1969－200972 16(22.2)22(30.6)26(36.1)2(2.8)46(63.9)15(20.8)1(1.4)2(2.8) 32(44.4)47(65.3)14(19.4)62.4 72.4
3Zhang et al[47]2001－200962 13(21.0)23(37.1)26(41.9) 22(35.5)11(17.7)2(3.2)  14(22.6)17(27.4)5(8.1) 36
4Wang et al[48]1980－2010102 19(18.6)56(54.9)27(26.5) 62(60.8)26(25.5)7(6.9)7(6.9) 22(21.6)87(85.3)33(32.4)65 72.8
5Qin et al[49]2002－201159 7(11.9)23(39.0)25(42.4)4(6.8)39(66.1)13(22.0)3(5.1)4(6.8) 38(64.4)22(37.3)29(49.2)45 61.0
6Ma et al[50]1994－201358 12(20.7)16(27.6)15(25.9)15(25.9)35(60.3)  3(5.2) 12(20.7)22(37.9)8(13.8) 4~11242.4
7Ye et al[51]1980－2014516(11.8)6(11.8)31(60.8)4(7.8)4(7.8)6(11.8)45(88.2)   32(62.7)28(54.9)13(25.5)60 89.6
8Xu et al[52]2000－2014114 24(21.1)66(57.9)23(20.2)1(0.9)55(48.2)48(42.1)5(4.4)  72(63.2)107(93.9)26(22.8)48 61.9
9Sun et al[53]2002－201852 13(25.0)19(36.5)11(21.2)9(17.3)3(5.8)35(67.3)10(19.2)  21(40.4)24(46.2)17(32.7)46 61.5
10Mo et al[54]1986－20181724(2.3)53(30.8)57(33.1)38(22.1) 71(41.3)71(41.3)7(4.1)3(1.7)19(11.0)145(84.3)92(53.5)99(57.6)42.7 82.4
11Qin et al[55]2015－201950 17(34.0)12(24.0)13(26.0)2(4.0) 32(64.0)11(22.0)3(6.0)13(26.0)42(84.0)26(52.0)10(20.0) 13.3~73.9 
总计  84410(1.2)201(23.8)342(40.5)217(25.7)42(5.0)354(41.9)319(37.8)55(6.5)22(2.6)32(3.8)448(53.1)498(59.0)285(33.8)   
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男性乳腺癌临床研究进展及中国研究现状
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王子行 1 , 王年昌 2 , 王翔宇 3, *
解放军医学杂志 | 综述 2021,46(7): 737-742
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解放军医学杂志 | 综述 2021, 46(7): 737-742
男性乳腺癌临床研究进展及中国研究现状
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王子行1, 王年昌2, 王翔宇3, *
作者信息
  • 1山东省济宁医学院基础医学院，山东济宁 272067
  • 2国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院防癌体检中心，北京 100021
  • 3国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院乳腺外科，北京 100021

    • 王子行，主要从事乳腺癌临床特点和预后关系、免疫治疗方面的研究

通讯作者:

王翔宇，E-mail：
Clinical research progress of male breast cancer and the research status in China
Zi-Xing Wang1, Nian-Chang Wang2, Xiang-Yu Wang3, *
Affiliations
  • 1School of Basic Medical Sciences, Jining Medical University, Jining, Shandong 272067, China
  • 2Department of Cancer Prevention, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • 3Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
出版时间: 2021-07-28 doi: 10.11855/j.issn.0577-7402.2021.07.15
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男性乳腺癌(MBC)是一种少见疾病，大部分为激素受体阳性，三阴性和HER2阳性的比例很低。MBC的治疗主要以根治术和改良根治术为主，前哨淋巴结活检也逐渐得到应用，术后辅助放疗的指征参照女性乳腺癌(FBC)。他莫昔芬是MBC辅助内分泌治疗的首选药物，能够改善预后。虽然抗HER2治疗的应用缺乏明确证据，但建议高危患者应用。新型药物的应用目前尚未见临床证据，但对于晚期患者其为可选方案。MBC总体预后较FBC差，但按照人口特征、分期、治疗方法等进行配对研究显示两者预后相似。MBC相关的前瞻性诊治研究较少，目前已发表的研究多为样本量较小的回顾性研究。该文综述MBC的病理特点、临床表现和诊断方法、治疗及预后等方面的研究进展，并汇总我国近10年来MBC的研究现状。

男性乳腺癌  /  病理  /  治疗  /  预后

Male breast cancer (MBC) is a rare disease for which almost no prospective studies have focused on its diagnosis and treatment. MBC is more likely to be positive for hormone receptor while the ratio of triple negative and human epidermal growth factor receptor 2 (HER2) positive is very low. Most men have undergone radical mastectomy and modified radical mastectomy after diagnosis of breast cancer during past decades and sentinel lymph node biopsy has been gradually used in recent years. The indications of postoperative adjuvant radiotherapy refer to female breast cancer (FBC). Tamoxifen is the first choice of adjuvant endocrine therapy for MBC and chemotherapy can also improve MBC patients' prognosis. Anti-HER2 therapy is recommended for patients with high risks, though there is no definite evidence for its application. Data for the use of new drugs in MBC are lacking,whereas it may be a reasonable approach for metastatic MBC. In general, the overall prognosis of MBC is worse than FBC, but a few studies showed that MBC and FBC had similar survival rates after adjustment for demographic characteristics, disease stage, and treatment. Most of published articles are retrospective studies including small cohorts of MBC patients, which have been reviewed in this article. The review summarizes current data on the epidemiology of MBC, pathological and clinical characteristics, prognosis and treatment, and data published in our country during the past decade.

male breast cancer  /  pathology  /  treatment  /  prognosis
王子行, 王年昌, 王翔宇. 男性乳腺癌临床研究进展及中国研究现状. 解放军医学杂志, 2021 , 46 (7) : 737 -742 . DOI: 10.11855/j.issn.0577-7402.2021.07.15
Zi-Xing Wang, Nian-Chang Wang, Xiang-Yu Wang. Clinical research progress of male breast cancer and the research status in China[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (7) : 737 -742 . DOI: 10.11855/j.issn.0577-7402.2021.07.15
正文
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男性乳腺癌(male breast cancer，MBC)是一种少见疾病，在乳腺癌及男性恶性肿瘤中占比均<1%[1]。统计数据显示，2019年美国新发MBC 2670例，死亡约500例；2015年我国新发MBC 3800例，死亡1200例[2-3]。MBC的中位发病年龄为65~67岁，较女性乳腺癌(female breast cancer，FBC)晚5~10年。近年来，MBC、FBC的发病率均呈上升趋势。美国监测、流行病学和最终结果(Surveillance,Epidemiology, and End Results，SEER)数据库显示，MBC发病率从1975年的0.85/10万升高至2014年的1.43/10万[4]。目前，MBC相关研究尤其是前瞻性研究极少，其治疗缺乏客观、准确的临床证据，临床医师常参照FBC的治疗经验，但由于男性激素水平、乳腺发育等的特殊性，FBC的治疗经验不一定完全适用于MBC。目前研究发现，BRCA2突变、家族史、年龄、雄激素/雌激素水平失衡和环境暴露可能是MBC的易感因素[5]。本文就MBC的病理特点、临床表现和诊断方法、治疗及预后等方面的研究进展进行综述，并汇总我国近10年来MBC的研究现状。
1 MBC的病理特点
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FBC的所有病理类型在MBC中都存在，但MBC的病理类型具有独特的特点。近90%的MBC为浸润性导管癌，小叶癌仅占1.5%，而FBC中小叶癌占比达15%，分析原因可能为男性乳腺中缺少腺泡和小叶所致[6]。男性导管原位癌占MBC的7%~11%，发病年龄较大且多为低级别原位癌，佩吉特病和炎性乳腺癌在MBC中极为少见[6-7]。
MBC最常见的分子分型是雌激素受体(ER)/孕激素受体(PR)阳性类型，在不同的年龄和种族中，MBC的分子分型有所不同。研究发现，MBC中ER/PR阳性、HER2扩增和三阴性乳腺癌的比例分别为82%~92%、2%~42%和0%~4%，患者越年轻，HER2阳性的概率越高[8-9]。有研究对2010—2012年SEER数据库中960例MBC患者进行分析发现，85%的MBC患者为激素受体(HR)阳性、HER2阴性，12%为HR阳性、HER2阳性，3%为HR阴性、HER2阴性，1%为HR阴性、HER2阳性[5]。
2 MBC的临床表现及诊断方法
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MBC通常表现为乳晕区的无痛质硬结节，乳头溢液不常见，而血性溢液与MBC相关，其他临床表现包括乳头回缩、局部皮肤凹陷、局部皮肤溃疡、与皮肤或肌肉粘连、腋窝淋巴结肿大等。MBC更容易侵犯乳头，可能与男性乳腺腺体较少且肿瘤多发生于中央区有关[6,10]。
关于MBC诊断方法的数据较少。MBC的诊断方法主要是临床评估，超声、钼靶评估，以及穿刺病理评估，与FBC基本相同[11]。2018年美国放射学会发布了男性乳房评估标准，建议25岁以下触及可疑肿块的男性以超声作为初步检查；对于25岁及以上或体格检查可疑的男性，建议以钼靶作为初步诊断检查，若钼靶检查结果不确定或提示癌症，则建议超声检查辅助诊断[12]。有研究发现，80%~90%的MBC可通过钼靶检查发现异常，且钼靶检查通常可以鉴别乳腺癌与乳腺良性疾病[13-14]。细针穿刺细胞学(FNA)检查可明确诊断大部分病例，但仍有近1/4的患者诊断不明确，此时建议切开活检或粗针穿刺(CNB)[15]。乳腺增强MRI应用于MBC的诊断仅见于个案报道，MBC的肿瘤形态与FBC相似[16]。
3 治疗
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3.1 局部治疗
3.1.1 手术
早期MBC的手术方式有保乳和单侧乳房全切，但目前大部分MBC患者选择乳腺癌改良根治术[17]。一项回顾性研究发现，保乳与单侧乳房全切的生存率相当，提示保乳对于MBC患者可能是一种安全的选择，但需进行前瞻性临床试验进一步验证。此外，保乳后放射治疗依从性较差的问题需要关注[17-18]。
目前，大量研究证实了FBC进行前哨淋巴结活检(sentinel lymph node biopsy，SLNB)的敏感度和特异度，避免了腋窝淋巴结清扫(axillary lymph node dissection，ALND)引起的并发症。因MBC较为少见，尚无大规模研究证实其SLNB的敏感度和特异度，部分小规模研究报告了SLNB应用于MBC的结果，例如，对6项来自美国的纳入患者≥25例且接受SLNB的MBC相关研究汇总显示，共230例患者，前哨淋巴结(sentinel lymph node，SLN)平均检出率约为98%，单示踪检出率低于双示踪，提示应尽可能采用双示踪SLNB[19](表1)；一项纳入78例MBC患者的研究发现，在进行SLNB后未行腋窝淋巴结清扫，随访(中位随访期28个月)未出现腋窝淋巴结复发[20]，提示SLNB应用于MBC安全可行。
3.1.2 辅助放疗
目前尚无前瞻性研究阐述辅助放疗对MBC的意义，但有回顾性研究发现，乳房全切的淋巴结阳性MBC患者术后辅助放疗可降低术后局部复发率[26-27]。一项纳入SEER数据库1998—2012年诊断为MBC患者的研究发现，对于保乳和符合放疗指征的全切患者，辅助放疗可以提高5年和10年总生存率[5]。目前MBC的术后放疗指征参考FBC指南，由于男性乳头和局部皮肤受侵的比例更高，有学者建议男性更应积极接受放疗[28]。
3.2 全身治疗
3.2.1 辅助内分泌治疗
82%~92%的MBC患者激素受体为阳性，目前研究建议至少使用他莫昔芬5年进行辅助内分泌治疗[29-30]。MBC与FBC的治疗时间都应基于复发风险和不良反应进行个性化制定[12]。Eggemann等[31]对257例MBC患者与2785例接受内分泌治疗的FBC患者进行比较，结果显示，FBC患者的平均随访时间为106个月，MBC患者为42个月；316例FBC患者和158例MBC患者接受他莫西芬治疗，5年总生存率分别为85.1%和89.2%；60例FBC患者和30例MBC患者接受芳香化酶抑制剂(AI)治疗，5年总生存率分别为85.0%和73.3%。在一项纳入257例Ⅰ~Ⅲ期MBC患者的研究中，50例接受AI治疗，207例接受他莫昔芬治疗，中位随访时间42个月，随访结果显示，接受AI治疗患者的死亡风险高于接受他莫昔芬治疗的患者(32% vs. 18%)[30]，表明他莫西芬是MBC辅助内分泌治疗的良好选择。
男性体内80%的雌激素是通过雄激素外周芳构化产生的，20%是由睾丸直接产生的，后者不被AI单独抑制，因此有学者建议男性采用AI联合促性腺激素释放激素类似物(GnRHa)治疗。目前关于GnRHa联合AI或他莫昔芬的前瞻性二期临床研究尚未报告预后结果[32-33]。若患者具有他莫昔芬禁忌证，建议采用AI联合GnRHa治疗[34]。
MBC患者服用他莫昔芬治疗的不良反应包括静脉血栓形成、性功能障碍、情绪变化、潮热、腿部抽筋、视力改变、认知改变和性欲降低等，20%~25%的激素受体阳性乳腺癌患者由于不良反应而停止服用他莫西芬[33,35]。哈尔滨医科大学附属肿瘤医院对116例受体阳性的MBC患者进行随访，结果显示，术后第1年64.6%的患者坚持服用他莫昔芬，术后第3年28.7%的患者坚持服用，仅不到20%的患者能够坚持服用5年；服用他莫昔芬5年及以上患者的5年和10年总生存率分别为97.9%和79.6%，5年和10年无病生存率分别为95.4%和72.8%；服用他莫昔芬少于5年患者的5年和10年总生存率分别为84.7%和50.4%，5年和10年无病生存率分别为72.6%和42.3%[29]。
3.2.2 辅助化疗及抗HER2治疗
目前尚无有关MBC辅助化疗获益的前瞻性研究，部分回顾性研究发现辅助化疗可使患者生存获益[12,28]。天津肿瘤医院回顾性分析了81例MBC患者的临床资料，结果显示，术后辅助化疗是患者无病生存期(disease-free survival，DFS)和总生存期(overall survival，OS)的独立影响因素[36]。美国癌症中心的一项研究发现，术后辅助化疗可提高腋窝淋巴结转移患者的5、10和20年总生存率[37]。辅助化疗的适应证和用药方案可参照FBC进行，但由于MBC患者年龄普遍较大，应结合患者实际情况决定用药方案。
乳腺癌21基因检测能够为ER阳性的FBC患者提供个体化的预后信息并帮助预测化疗获益情况，但MBC的21基因检测相关数据非常有限。2018年发表的一项研究分析了3806例MBC和571 115例FBC的复发分数(recurrence score，RS)，发现MBC与FBC的平均RS及RS<18的比例相近(平均RS：16.8% vs.17.0%；RS<18的比例：58.0% vs. 58.2%)，但MBC RS≥31和RS<11的比例均明显高于FBC(RS≥31的比例：12.4% vs. 7.4%；RS<11的比例：33.8% vs.22.1%)；进一步分析具有预后数据的322例MBC和55 842例FBC发现，RS<18、RS 18~30、RS≥31的患者5年乳腺癌特异生存率分别为99.0%、99.5%、95.9%和98.6%、81.0%、94.9%，表明21基因检测可以应用于MBC，并可提供预后信息和化疗获益情况[38]。
目前尚无明确的研究证实HER2阳性MBC可从抗HER2治疗中获益。一项回顾性研究纳入了32例HER2阳性的MBC患者，其中15例接受了赫赛汀治疗，由于样本量小，该研究未得出HER2阳性对MBC预后的影响及赫赛汀是否可使HER2阳性MBC患者获益的结果，但仍建议存在复发高危因素的患者接受抗HER2治疗[37]。另一项研究分析了2010—2015年SEER数据库中HER2阳性的MBC患者，发现HER2阳性是MBC预后不良的影响因素，提示抗HER2治疗对MBC预后具有潜在的改善作用[39]。
3.2.3 新型药物的应用
周期蛋白依赖性激酶4/6(CDK4/6)抑制剂、哺乳动物雷帕霉素靶蛋白(mTOR)抑制剂、帕妥珠单抗、曲妥珠单抗-美坦新偶联物(T-DM1)、程序性细胞死亡蛋白-1(PD-1)抑制剂及其配体PD-L1抑制剂等新型药物近年来已逐渐应用于FBC，但在MBC中的应用暂未见明确证据，对于早期MBC不建议常规使用，但晚期MBC应完全参照FBC治疗[40]。美国食品和药物管理局(FDA)在2019年4月批准CDK4/6抑制剂帕博西尼(palbociclib)用于治疗晚期MBC[41]。
4 预后
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MBC预后的影响因素与FBC类似。多项回顾性研究分析了MBC的预后因素，例如，法国一项纳入489例MBC的研究发现，早期诊断、辅助内分泌治疗、辅助化疗和辅助放疗是降低局部复发率和提高总生存率的影响因素，肿瘤大小和淋巴结状态是预后的预测因素[42]；美国一项纳入10 873例MBC的研究发现，发病年龄大、黑色人种、查尔森合并症指数高、肿瘤组织学分级高、分期晚和接受全切手术是MBC预后的不利因素，而高收入地区、PR阳性肿瘤、化疗、放疗和内分泌治疗是MBC预后的有利因素[42]。
既往普遍认为MBC预后较FBC差，原因可能为对MBC的认识不足导致其诊断容易被延误。有研究发现，MBC从发现乳房肿块至诊断的时间长达12个月以上，而导致延误诊断的原因主要为男性缺乏乳腺癌防癌意识、窘迫感和社会支持[43]。近年来有研究将MBC和FBC患者按照分期、年龄、激素受体状态等进行配对分析，发现MBC的预后与FBC接近甚至更好[7,44]。因此，提高男性的防癌意识，早期发现、诊断和治疗MBC对改善预后非常重要。
5 我国MBC研究现状
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以“男性乳腺癌”为关键词，发表时间设定为2008—2020年，检索万方数据库共得到2846篇文献，进一步筛选纳入病例>50例的研究，共16篇符合条件，删除5篇与另外11篇研究相比所纳入的病例数据不全或相同，最终纳入11篇文献(共844例MBC患者)，纳入病例的时间为1969—2019年，提取所需数据并汇总发现，我国MBC患者多集中在Ⅰ(23.8%)、Ⅱ(40.5%)、Ⅲ(25.7%)期，以Ⅱ期最多，0期(1.2%)和Ⅳ期(5.0%)较少；手术方式多采用经典根治术(41.9%)与改良根治术(37.8%)，较少行单纯切除术(6.5%)、保乳术(2.6%)与SLNB(3.8%)。化疗、内分泌治疗和放疗的占比分别为59.0%、53.1%和33.8%，部分患者多项辅助治疗联合使用，但内分泌治疗的比例(53.1%)明显低于理论上HR阳性患者的比例(82%~92%)，提示我国HR阳性MBC内分泌治疗比例仍有待提高；5年总生存率为42.4%~89.6%，临床分期对总生存率影响较大，与纳入Ⅳ期患者少或无Ⅳ期患者的研究相比，纳入Ⅳ期患者较多的研究5年总生存率最低(表2)。
由于对MBC的重视程度不够，且存在误诊、漏诊、漏治现象，影响患者预后，国外临床辅助诊断一般首选钼靶检查，辅以超声检查，但由于我国MBC患者乳房体积较小，很难行乳腺钼靶检查，而超声诊断的灵敏度、特异度均较高，有助于鉴别诊断，对于辅助检查高度怀疑恶性者，需对肿块行粗针穿刺活检以明确病理诊断。此外，由于我国患者乳房体积较小，肿块易侵犯胸肌并发生胸肌间和腋窝淋巴结转移，因此，改良根治术并不能完全取代经典根治术；我国MBC发病率低，发病年龄大，加强对该病的科普宣传，早发现、早诊断以及完善的综合治疗，尤其是内分泌治疗(首选他莫昔芬)是改善预后的关键[45-55]。
6 总结与展望
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对于MBC，临床医师主要参照FBC相关研究和临床经验开展工作，未来尚需进一步研究如致病原因、不同手术方式的获益和风险、SLNB的准确度及特异度、辅助化疗用药及效果、如何减少辅助内分泌治疗的并发症及提高服药的依从性，以及MBC患者心理及生活质量调查等。目前全球正在开展关于MBC的前瞻性研究，以期能够解决MBC相关的临床问题，并规范MBC的诊治，提高MBC的诊治水平。
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2021年第46卷第7期
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doi: 10.11855/j.issn.0577-7402.2021.07.15
  • 接收时间：2021-01-22
  • 首发时间：2025-12-20
  • 出版时间：2021-07-28
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  • 收稿日期：2021-01-22
  • 修回日期：2021-06-08
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    1山东省济宁医学院基础医学院，山东济宁 272067
    2国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院防癌体检中心，北京 100021
    3国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院乳腺外科，北京 100021

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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