Male breast cancer. Does the prognosis differ compared to female?

Due to the low incidence of breast cancer in males there are not many reports in the literature. In this study we analyzed results of treatment in 65 breast cancer males, who had been treated in one institution. Radical surgery was performed in 45 patients. Lymph node metastases were found in 25 patients (55.5%), the tumor was usually moderately differentiated (21 pts - 46.7%). Median survival after radical surgery was 73 months compared to 38 months for nonsurgical patients (p < 0.0001). In the group of males after radical surgery the results of 5-, 10- and 15-year survival rates were 69.8, 59.7 and 31.3% respectively. Comparable analysis of two subgroups of patients with favorable (T1 or T2, N0, grade I or II) and unfavorable (T3 or N+ or grade III) prognostic factors was also performed. In the first subgroup the 5-, 10- and 15-year survival rates were 90, 77.4 and 62%, compared to 61.8, 23.1 and 23. 1% for the second subgroup. The multivariate analysis showed grading and node status as the strongest parameters influencing survival. Relative risk of death was over 3 times higher for nodal metastases and near 3 times higher for high grade carcinomas (p < 0.01), compared to patients without metastases and low grade of tumor. Similar analysis was performed when 45 males were compared to 500 selected women, with similar clinical parameters (age, node status, grading). Again, data indicated grading and lymph node status as the strongest prognostic factors. It was not unlikely, that gender had some influence on prognosis, when relative risk of death for males was over 1.5 times higher than for females, but this result was not clearly significant (p < 0.1 ). The question, whether male breast cancer prognosis is worse then in female remains open. Multiinstitutional prospective studies are needed in this area.

Retroperitoneal sarcoma--the continued challenge for surgery and oncology.

Retroperitoneal sarcomas (RS) are rare malignant tumours with an incidence rate of about 1-2 cases per million per year. Therefore only a few centres are able to acquire more experience in this field. Tumours are usually of large size, due to slow growth and uncommon symptoms. Different histologic types, grades and rare incidence make any comparison difficult. Radical excision including adjacent organs, called "en-block" resection, is the treatment of choice, however it is very often difficult to obtain adequate free margins around the tumour. Complete tumour excision remains a challenge even for an experienced surgeon. In the published series, resectability ranges from 38 to 100% with radicality rate between 8 and 95%. Local recurrence is very common (33-86%), with rare distant metastases (max. 33%), so local failure is usually the cause of death. It is well known that histological grading and completeness of surgery determine the chance of survival. Five-year survival rates after radical excision ranged from 62-92% in well-differentiated tumours, compared with 16-48% in nondifferentiated sarcomas. There is no evidence that adjuvant or neoadjuvant treatment affects the prognosis. Only the development of an international registry of retroperitoneal sarcoma and co-operative intergroup studies can help in evaluating treatment and in applying innovative multimodal therapies to these neoplasms.