Objective  To explore the prognostic factors of male breast cancer (MBC) patients, and construct a survival prognostic nomogram for MBC patients, and predict the 3-year and 5-year overall survival rates.

Methods  Patients from the Surveillance, Epidemiology, and End Results (SEER) cancer registry database were included, along with MBC patients from the Affiliated Hospital of North Sichuan Medical College, Suining Central Hospital, and Deyang People's Hospital. Clinical baseline data and survival information of the patients were obtained. The data of patients from the SEER database served as the training coherent, and the data of patients from 3 hospitals as the validation coherent. Independent prognostic factors for the overall survival (OS) of MCB patients were determined by univariate and multivariate Cox regression analysis. A nomogram predicting 3-year and 5-year survival rates for MBC patients was constructed based on the independent prognostic factors, and its accuracy and practical application value were assessed using calibration curves, the concordance index (C-index), receiver operating characteristic curves (ROC), and decision curve analysis (DCA).

Results  A total of 3,387 MBC patients were included, 3,307 patients were in training coherent and 80 patients were in validation coherent. After univariate and multivariate Cox regression analysis of the training set, it was found that diagnostic age, histological grade, TNM stage, prgesterone receptor status, surgery, chemotherapy, and radiotherapy were the independent prognostic factors for MBC. These factors were incorporated into the nomogram model and validated, with a C-index of 0.711 for the training set and 0.787 for the external validation set. In the training set, the nomogram showed an AUC of 0.744 for 3-year OS and an AUC of 0.720 for 5-year OS; in the validation set, the nomogram showed an AUC of 0.835 for 3-year OS and an AUC of 0.858 for 5-year OS. The ROC curve indicated good discriminative ability of the model, the calibration curve showed good predictive performance, and the DCA curve indicated high clinical utility of the model.

Conclusion  The nomogram provides a reliable and practical method for predicting the prognosis of MBC patients, aiding in personalized treatment decisions and thereby improving patient outcomes.

1.Gucalp A, Traina TA, Eisner JR, et al. Male breast cancer: a disease distinct from female breast cancer[J]. Breast Cancer Res Treat, 2019, 173(1): 37-48.DOI: 10.1007/s10549-018-4921-9.

2.宋爱琳, 欧江华. 中国男性乳腺癌临床诊治实践指南(2023版)[J]. 中国实用外科杂志, 2023, 43(2): 139-143. [Song AL, Ou JH. Chinese guidelines for clinical diagnosis and treatment of male breast cancer (2023 edition)[J]. Chinese Journal of Practical Surgery, 2023, 43(2): 139-143.] DOI: 10.19538/j.cjps.issn1005-2208.2023.02.04.

3.Giordano SH, Buzdar AU, Hortobagyi GN. Breast cancer in men[J]. Ann Intern Med, 2002, 137(8): 678-687. DOI: 10.7326/0003-4819-137-8-200210150-00013.

4.Cardoso F, Bartlett JMS, Slaets L, et al. Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG international male breast cancer program[J]. Ann Oncol, 2018, 29(2): 405-417. DOI: 10.1093/annonc/mdx651.

5.Leone JP, Hassett MJ, Leone J, et al. Efficacy of neoadjuvant chemotherapy in male breast cancer compared with female breast cancer[J]. Cancer, 2022, 128(21): 3796-3803. DOI: 10.1002/cncr.34448.

6.Chatterji S, Krzoska E, Thoroughgood CW, et al. Defining genomic, transcriptomic, proteomic, epigenetic, and phenotypic biomarkers with prognostic capability in male breast cancer: a systematic review[J]. Lancet Oncol, 2023, 24(2): e74-e85. DOI: 10.1016/S1470-2045(22)00633-7.

7.Yao N, Shi W, Liu T, et al. Clinicopathologic characteristics and prognosis for male breast cancer compared to female breast cancer[J]. Sci Rep, 2022, 12(1): 220. DOI: 10.1038/s41598-021-04342-0.

8.Ruddy KJ, Winer EP. Male breast cancer: risk factors, biology, diagnosis, treatment, and survivorship[J]. Ann Oncol, 2013, 24(6): 1434-1443.DOI: 10.1093/annonc/mdt025.

9.Leone JP, Freedman RA, Leone J, et al. Survival in male breast cancer over the past 3 decades[J]. J Natl Cancer Inst, 2023, 115(4): 421-428. DOI: 10.1093/jnci/djac241.

10.Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: more than meets the eye[J]. Lancet Oncol, 2015, 16(4): e173-e180. DOI: 10.1016/S1470-2045(14)71116-7.

11.Brinton LA, Cook MB, McCormack V, et al. Anthropometric and hormonal risk factors for male breast cancer: male breast cancer pooling project results[J]. J Natl Cancer Inst, 2014, 106(3): djt465 DOI: 10.1093/jnci/djt465.

12.Chai X, Sun MY, Jia HY, et al. A prognostic nomogram for overall survival in male breast cancer with histology of infiltrating duct carcinoma after surgery[J]. Peer J, 2019, 7: e7837. DOI: 10.7717/peerj.7837.

13.Pegoraro RJ, Nirmul D, Joubert SM. Cytoplasmic and nuclear estrogen and progesterone receptors in male breast cancer[J]. Cancer Research, 1982, 42(11): 4812-4814. https://pubmed.ncbi.nlm.nih.gov/7127316/.

14.Eggemann H, Altmann U, Costa SD, et al. Survival benefit of tamoxifen and aromatase inhibitor in male and female breast cancer[J]. J Cancer Res Clin Oncol, 2018, 144(2): 337-341. DOI: 10.1007/s00432-017-2539-7.

15.Hassett MJ, Somerfield MR, Baker ER, et al. Management of male breast cancer: ASCO Guideline[J]. J Clin Oncol, 2020, 38(16): 1849-1863. DOI: 10.1200/JCO.19.03120.

16.王鑫, 吴其佑, 连至炜, 等. HER2阳性乳腺癌患者选择靶向治疗的影响因素分析[J]. 中国循证医学杂志, 2023, 23(1): 7-13. [Wang X, Wu QY, Lian ZW, et al. Analysis of influential factors in selecting targeted therapy for HER2-positive breast cancer patients[J]. Chinese Journal of Evidence-Based Medicine, 2023, 23(1): 7-13.] http://qikan.cqvip.com/Qikan/Article/Detail?id=7108936139.

17.豆妮娜, 袁欣, 王帅兵, 等. 他莫昔芬代谢产物endoxifen的研究进展[J]. 中国药师, 2022, 25(5): 867-872. [Dou NN, Yuan X, Wang SB, et al. Research progress in tamoxifen metabolite endoxifen[J]. China Pharmacist, 2022, 25(5): 867-872.] DOI: 10.19962/j.cnki. issn1008-049X.2022.05.021.

18.Chen SY, Liu Y, Yang J, et al. Development and validation of a nomogram for predicting survival in male patients with breast cancer[J]. Front Oncol, 2019, 9: 361. DOI: 10.3389/fonc.2019.00361.

19.Vaz-Luis I, Ottesen RA, Hughes ME, et al. Outcomes by tumor subtype and treatment pattern in women with small, node-negative breast cancer: a multi-institutional study[J]. J Clin Oncol, 2014, 32(20): 2142-2150. DOI: 10.1200/JCO.2013.53.1608.

20.Ignatov T, Eggemann H, Burger E, et al. Management of small T1a/b breast cancer by tumor subtype[J]. Breast Cancer Res Treat, 2017, 163(1): 111-118. DOI: 10.1007/s10549-017-4168-x.

21.赵曦, 闫茜, 李宁, 等. 阿贝西利联合氟维司群二线治疗HR+/HER2-晚期乳腺癌的成本-效果分析[J]. 药物流行病学杂志, 2023, 32(11): 1259-1266. [Zhao  X, Yan Q, Li N, et al. Cost-effectiveness analysis of abexil combined with fluvestrant in second-line treatment of HR+/HER2-advanced breast cancer[J]. Chinese Journal of Pharmacoepidemiology, 2023, 32(11): 1259-1266.] DOI: 10.19960/j.issn.1005-0698.202311009.

22.Wang Z, Shao H, Xu Q, et al. Establishment and verification of prognostic nomograms for young women with breast cancer bone metastasis[J]. Front Med (Lausanne), 2022, 9: 840024. DOI: 10.3389/fmed.2022.840024.

23.Zhang LP, Lin H, Wang AJ. Development and validation of a nomogram to predict survival for advanced male breast cancer[J]. Andrologia, 2022, 54(8): e14479. DOI: 10.1111/and.14479.