Рак молочной железы у мужчин (обзор литературы)

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Аннотация

Рак молочной железы у мужчин (РМЖМ) является редким заболеванием, составляющим примерно 0,1% от всех злокачественных опухолей у мужчин. Принципы лечения РМЖМ основаны на принципах лечения РМЖ у женщин (РМЖЖ). Факторами риска РМЖМ являются возраст, генетическая предрасположенность, раса, уровень половых гормонов и факторы окружающей среды. У большинства мужчин заболевание выявляется позднее и на более распространенной стадии в сравнении с женщинами. Опухоли часто являются эстроген- и прогестерон-рецептор-положительными, наиболее часто встречаемый гистологический тип – инвазивный протоковый рак. Трехуровневый метод остается стандартным методом постановки диагноза. При первичном РМЖМ наиболее часто в качестве I этапа лечения выполняется простая мастэктомия, также возможен вариант органосохраняющей операции, но при этом повышается риск рецидива. Биопсия сигнальных лимфоузлов рекомендуется в качестве первичного метода стадирования при клинически негативных (N0) регионарных лимфоузлах. Данные о реконструктивной хирургии, проводимой с целью первичного закрытия кожного дефекта, и о лучевой терапии взяты из имеющихся данных о лечении РМЖЖ. Химиотерапия (ХТ) рекомендуется мужчинам при более распространенных (чем р T1N0M0) стадиях заболевания, особенно в случаях ER-отрицательных опухолей. При РМЖМ отмечается хороший ответ на гормонотерапию, хотя при этом наблюдаются выраженные побочные явления. Ингибиторы ароматазы III поколения являются перспективной для изучения группой препаратов, но вызывают сомнения ввиду их неспособности подавлять синтез эстрогенов в яичках. При РМЖМ эффективность фулвестранта не доказана, данные о назначении трастузумаба при экспрессии HER2 сомнительны и неясны. При метастатическом РМЖМ гормонотерапия остается терапией 1-й линии с последующим возможным назначением системной ХТ при гормонорезистентном РМЖМ. За последние 30 лет прогноз при РМЖМ у мужчин стал более благоприятным, выживаемость зависит от стадии заболевания, уровня экспрессии рецепторов стероидных гормонов, гистологического типа опухоли и сопутствующей патологии.

Ключевые слова: мужской рак молочной железы, диагностика, лечение.

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Male breast cancer (MBC) is a rare condition that accounts for 0,1% of all male cancers. Our current evidence base for treatment is derived from female breast cancer (FBC) patients. Risk factors for MBC include age, genetic predisposition, race, sex hormone exposure, and environmental factors. Most patients present later and with more advanced disease than comparable FBC patients. Tumors are likely to be estrogen receptor and progesterone receptor positive, with the most common histologic type being invasive ductal carcinoma. Triple assessment remains the criterion standard for diagnosis. Primary MBC is mostly managed initially by simple mastectomy, with the option of breast conserving surgery, which carries an increased risk of recurrence. Sentinel node biopsy is recommended as the initial procedure for staging the axilla. Reconstructive surgery focuses on achieving primary skin closure, and radiotherapy largely follows treatment protocols validated in FBC. We recommend chemotherapy for men with more advanced disease, in particular, those with estrogen receptor negative histology. MBC responds well to endocrine therapy, although it is associated with significant adverse effects. Third-generation aromatase inhibitors are promising but raise concerns due to their failure to prevent estrogen synthesis in the testes. Fulvestrant remains unproven as a therapy, and data on trastuzumab is equivocal with HER2-receptor expression and functionality unclear in MBC.
In metastatic disease, drug-based hormonal manipulation remains a first-line therapy, followed by systemic chemotherapy for hormone-refractory disease. Prognosis for MBC has improved over the past 30 years, with survival affected by disease staging, histologic classification, and comorbidity.

Key words: male breast cancer, diagnostic, treatment.

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Авторы

К.С.Николаев1, В.Ф.Семиглазов1, В.В.Семиглазов2

1 ФГБУ НИИ онкологии им. Н.Н.Петрова Минздрава России, Санкт-Петербург;
2 ГБОУ ВПО Санкт-Петербургский государственный медицинский университет им. акад. И.П.Павлова Минздрава России

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K.S.Nikolaev1, V.F.Semiglazov1, V.V.Semiglazov2

1 N.N.Petrov Research Institute of Oncology (197758, Leningradskaya Str. 68, Pesochny-2, St.-Petersburg, Russia);
2 I.P.Pavlov Saint-Petersburg State Medical University (197022, L'va Tolstogo str. 6/8, St.-Petersburg, Russia)

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