ImportanceIn women with hormone receptor–positive (HR+) breast cancer, the risk of distant recurrence and death persists for at least 20 years from diagnosis. The risk of late mortality in men with HR+ breast cancer has not been reported.ObjectiveTo report 20-year risks of breast cancer–specific mortality (BCSM) and non-BCSM in men with stage I to III HR+ breast cancer and identify factors associated with late BCSM.Design, Setting, and ParticipantsAn observational cohort study was conducted of men diagnosed with HR+ breast cancer from 1990 to 2008, using population-based data from the Surveillance, Epidemiology, and End Results program. Men diagnosed with stage I to III HR+ breast cancer were included in the analysis. Cumulative incidence function was used to estimate the outcomes of baseline clinicopathologic variables regarding cumulative risk of BCSM and non-BCSM since diagnosis. Smoothed hazard estimates over time were plotted for BCSM. Fine and Gray multivariable regression evaluated the association of preselected variables with BCSM, conditional on having survived 5 years.Main Outcome MeasureBCSM.ResultsA total of 2836 men with stage I to III HR+ breast cancer were included, with a median follow-up of 15.41 (IQR, 12.08-18.67) years. Median age at diagnosis was 67 (IQR, 57-76) years. The cumulative 20-year risk of BCSM was 12.4% for stage I, 26.2% for stage II, and 46.0% for stage III. Smoothed annual hazard estimates for BCSM revealed an increase in late hazard rates with each incremental node category, reaching a bimodal distribution in N3 and stage III, with each having peaks in hazard rates at 4 and 11 years. Among patients who survived 5 years from diagnosis, the adjusted BCSM risk was higher for those younger than 50 years vs older than 64 years, those with grade II or III/IV vs grade I tumors, and stage II or III vs stage I disease.Conclusions and RelevanceThe findings of this study suggest that, in men with stage I to III HR+ breast cancer, the risk of BCSM persists for at least 20 years and depends on traditional clinicopathologic factors, such as age, tumor stage, and tumor grade. Among men with higher stages of disease, the kinetics of the BCSM risk appear different from the risk that has been reported in women.

中文翻译：

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患有 I 至 III 期激素受体阳性乳腺癌的男性 20 年来的死亡风险

对于激素受体阳性（HR+) 乳腺癌，远处复发和死亡的风险在诊断后至少持续 20 年。HR 男性晚期死亡的风险+尚未报道乳腺癌。目的报告 I 至 III HR 期男性的 20 年乳腺癌特异性死亡率 (BCSM) 和非 BCSM 风险+乳腺癌并确定与晚期 BCSM 相关的因素。设计、设置和参与者对诊断为 HR 的男性进行了观察性队列研究+使用来自监测、流行病学和最终结果计划的基于人群的数据，对 1990 年至 2008 年的乳腺癌进行了调查。诊断为 I 至 III HR 期的男性+乳腺癌被纳入分析中。累积发生率函数用于估计自诊断以来有关 BCSM 和非 BCSM 累积风险的基线临床病理变量的结果。BCSM 绘制了随时间推移的平滑危险估计。Fine 和 Gray 多变量回归评估了预选变量与 BCSM 的关联，条件是存活 5 年。主要结果测量 BCSM。结果共有 2836 名 I 至 III 期 HR 男性+乳腺癌也被纳入其中，中位随访时间为 15.41（IQR，12.08-18.67）年。诊断时的中位年龄为 67 岁（IQR，57-76）岁。I 期 BCSM 的 20 年累积风险为 12.4%，II 期为 26.2%，III 期为 46.0%。BCSM 的平滑年度灾害估计显示，后期灾害率随着每个增量节点类别的增加而增加，在 N3 和 III 阶段达到双峰分布，每个灾害率在 4 年和 11 年出现峰值。在诊断后存活 5 年的患者中，50 岁以下患者与 64 岁以上患者、II 级或 III/IV 级肿瘤患者与 I 级肿瘤患者以及 II 期或 III 期疾病患者相比，调整后的 BCSM 风险较高。结论和相关性 这项研究的结果表明，在 I 至 III 期 HR 的男性中+乳腺癌中，BCSM 的风险持续至少 20 年，并且取决于传统的临床病理因素，例如年龄、肿瘤分期和肿瘤分级。在疾病处于较高阶段的男性中，BCSM 风险的动力学似乎与女性中报告的风险不同。