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Despite Equivalent Outcomes, Men Receive Neoadjuvant Chemotherapy Less Often Than Women for Lymph Node-Positive
Lifen Cao1,2, Jonathan J Hue1,2, Mary Freyvogel1,2
1Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Annals of Surgical Oncology
|April 7, 2021
Summary
Male breast cancer patients receive less neoadjuvant chemotherapy (NAC) than females, despite similar outcomes. Increased NAC use in men with node-positive breast cancer could improve downstaging and treatment efficacy.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Oncology
Background:
- Neoadjuvant chemotherapy (NAC) is crucial for downstaging breast cancer and informing prognosis.
- Male breast cancer patients often face poorer outcomes and less treatment compared to females.
- Existing data suggest a disparity in NAC utilization based on sex.
Purpose of the Study:
- To investigate the association between patient sex and NAC utilization in breast cancer.
- To determine if sex influences NAC response and overall survival.
- To compare treatment patterns and outcomes between male and female breast cancer patients.
Main Methods:
- Analysis of the National Cancer Database (2004-2016) for patients with cN1-3 breast cancer.
- Multivariable logistic regression to assess NAC use and response by sex.
- Multivariable Cox models to analyze overall survival in relation to sex and NAC.
Main Results:
- Fewer males (26%) received NAC compared to females (45%), despite similar tumor and demographic factors.
- Males underwent more mastectomies and axillary lymph node dissections.
- Sex was not associated with pathologic response or overall survival after NAC.
Conclusions:
- Male breast cancer patients with node-positive disease receive less NAC and more aggressive surgery than females.
- Oncologic outcomes after NAC are comparable between sexes for cN1-3 breast cancer.
- NAC should be considered for appropriate male patients to facilitate tumor downstaging.
