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Despite Equivalent Outcomes, Men Receive Neoadjuvant Chemotherapy Less Often Than Women for Lymph Node-Positive Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemotherapy (NAC) downstages breast cancer and provides prognostic information. Males with breast cancer are known to receive less treatment overall and have poorer outcomes relative to females. We hypothesized that males would be less likely to receive NAC.

Patients and methods

Patients with a primary diagnosis of cN1–3 breast cancer were identified in the National Cancer Database (2004–2016). Multivariable logistic regression determined the association between NAC utilization and sex, and the relationship between sex and NAC response, controlling for demographic and tumor factors. Overall survival was analyzed using a multivariable Cox model.

Results

In total, 196,027 patients (194,010 females, 2017 males) met inclusion criteria. A significantly greater proportion of males underwent mastectomy (80% vs. 60%, P < 0.001), and axillary lymph node dissection (76% vs. 74%, P = 0.022). Overall fewer men received chemotherapy than women (73% vs. 84%, P < 0.001); men also received NAC at a significantly lower rate (26% men vs. 45% women, P < 0.001). After accounting for demographic and oncologic factors including hormone receptor (HR) subtype, females remained more likely to undergo NAC (OR 1.84, P < 0.001). On multivariable analysis, sex was not associated with pathologic response or overall survival after NAC.

Conclusions

Although oncologic outcomes after NAC were similar, males with node-positive breast cancer received less NAC and more aggressive surgery than females. These data suggest men achieve outcomes comparable to women with cN1–3 disease, and NAC should be used in appropriate male patients to downstage the breast and axilla.

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Acknowledgment

This research did not receive any specific funding from agencies in the public, commercial, or nonprofit sectors except the institutional funds made available to the authors.

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Author notes

  1. Lifen Cao and Jonathan J. Hue have contributed equally to this manuscript.

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Lifen Cao MD PhD, Jonathan J. Hue MD, Mary Freyvogel DO, Pamela Li MD, Lisa Rock MD, Ashley Simpson DO, Jill Dietz MD, Robert Shenk MD FACS & Megan E. Miller MD FACS

  2. University Hospitals Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, OH, USA

    Lifen Cao MD PhD, Jonathan J. Hue MD, Mary Freyvogel DO, Pamela Li MD, Lisa Rock MD, Ashley Simpson DO, Jill Dietz MD, Robert Shenk MD FACS & Megan E. Miller MD FACS

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  1. Lifen Cao MD PhD
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  2. Jonathan J. Hue MD
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Correspondence to Megan E. Miller MD FACS.

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This study was presented in e-Poster format at the Society of Surgical Oncology International Conference on Surgical Cancer Care, March 18-19, 2021

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Cao, L., Hue, J.J., Freyvogel, M. et al. Despite Equivalent Outcomes, Men Receive Neoadjuvant Chemotherapy Less Often Than Women for Lymph Node-Positive Breast Cancer. Ann Surg Oncol 28, 6001–6011 (2021). https://doi.org/10.1245/s10434-021-09857-4

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  • DOI: https://doi.org/10.1245/s10434-021-09857-4

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