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Prevalencia de antecedentes andrológicos en pacientes con cáncer de mama masculino
Prevalence of men's health history in male breast cancer patients
Maria Florencia Scagliottia,
Autor para correspondencia
florscagliotti@gmail.com

Autor para correspondencia.
, Bruno Rafael Boiettib, Pablo Knoblovitsa
a Servicio de Endocrinología y Metabolismo, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
b Área de Investigación Medicina Interna, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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y encontraron una fuerte relaci&#243;n con los niveles de estradiol<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los factores de riesgo postulados para el c&#225;ncer de mama masculino sugieren la importancia de los factores antropom&#233;tricos y hormonales como el s&#237;ndrome de Klinefelter &#40;SK&#41; y la ginecomastia<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a>&#46; El historial reproductivo tambi&#233;n puede estar asociado con el riesgo&#59; varios estudios han demostrado relaci&#243;n entre el c&#225;ncer de mama masculino y antecedentes como pubertad tard&#237;a&#44; infertilidad y criptorquidia&#44; traumatismo testicular e infecciones que causan orquitis o epididimitis&#44; afecciones a menudo asociadas con la ginecomastia<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> y con hipogonadismo primario&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El objetivo principal del presente estudio es estimar la prevalencia de antecedentes androl&#243;gicos en los pacientes masculinos con c&#225;ncer de mama que consultaron en el Hospital Italiano de Buenos Aires en el per&#237;odo comprendido entre el 1 de enero de 2010 y el 1 de diciembre de 2018&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Material y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio de corte transversal&#44; retrospectivo y observacional que evalu&#243; los antecedentes androl&#243;gicos&#44; cl&#237;nicos y antropom&#233;tricos de los pacientes con c&#225;ncer de mama masculino&#44; as&#237; como las caracter&#237;sticas cl&#237;nicas y anatomopatol&#243;gicas del tumor&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se incluy&#243; a todos los hombres cisg&#233;nero&#44; mayores de 18 a&#241;os&#44; con antecedentes de c&#225;ncer de mama registrados en el Hospital Italiano de Buenos Aires desde el 1 de enero de 2010 hasta el 1 de diciembre de 2018&#46; Se excluyeron del estudio a los hombres y mujeres transg&#233;nero con terapia hormonal de afirmaci&#243;n de g&#233;nero&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El Hospital Italiano de Buenos Aires forma parte del subsistema privado de atenci&#243;n sanitaria&#46; Adem&#225;s&#44; cuenta con la acreditaci&#243;n como hospital acad&#233;mico otorgada por la <span class="elsevierStyleItalic">Joint Commission International</span> y especialidades de referencia como endocrinolog&#237;a y patolog&#237;a mamaria&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se confeccion&#243; una base de datos con todos los pacientes hombres cisg&#233;nero mayores de 18 a&#241;os y que&#44; adem&#225;s&#44; ten&#237;an consignado en la historia cl&#237;nica electr&#243;nica los siguientes t&#233;rminos&#58; c&#225;ncer de mama&#44; ecograf&#237;a mamaria&#44; mamograf&#237;a&#44; mastectom&#237;a&#44; radioterapia mamaria&#44; tamoxifeno&#44; inhibidores de la aromatasa o an&#225;logos de la hormona liberadora de gonadotropina &#40;acetato de triptorelina o de leuprolida&#41;&#44; citolog&#237;a y anatom&#237;a patol&#243;gica compatible con carcinoma de mama&#46; Se revisaron 2&#46;932 historias cl&#237;nicas electr&#243;nicas de pacientes&#44; de los cuales incluimos 57 hombres con diagn&#243;stico de c&#225;ncer de mama&#46; En una segunda etapa se contact&#243; telef&#243;nicamente a los pacientes incluidos en el estudio para completar los antecedentes androl&#243;gicos faltantes mediante una encuesta estructurada&#44; previo consentimiento informado&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se describieron las variables continuas como medias y desviaci&#243;n est&#225;ndar o como medianas e intervalo intercuart&#237;lico seg&#250;n la distribuci&#243;n observada&#44; y las variables categ&#243;ricas como frecuencias absolutas y relativas &#40;porcentajes&#41;&#46; Los datos descriptivos fueron comparados con test de Chi cuadrado o test de Fisher&#44; seg&#250;n supuestos&#44; para variables categ&#243;ricas y t-test o Mann Whitney en variables continuas&#44; seg&#250;n su distribuci&#243;n&#46; Los datos se almacenaron en una base de datos Access y se procesaron con el programa STATA 14&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El estudio fue conducido de acuerdo con las normas de Helsinki&#44; bajo consentimiento informado&#44; y fue aprobado por el Comit&#233; de &#233;tica en investigaci&#243;n del Hospital Italiano de Buenos Aires&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto a los antecedentes androl&#243;gicos consignados en la historia cl&#237;nica electr&#243;nica 2&#47;36 &#40;5&#44;56&#37;&#41; pacientes refer&#237;an infertilidad&#44; 14&#47;48 &#40;29&#44;17&#37;&#41; ginecomastia&#44; 17&#47;28 &#40;60&#44;71&#37;&#41; disfunci&#243;n sexual&#44; 1&#47;21 &#40;4&#44;76&#37;&#41; pubertad tard&#237;a&#44; 2&#47;23 &#40;8&#44;70&#37;&#41; bajo volumen testicular&#44; 2&#47;22 &#40;9&#44;09&#37;&#41; orquitis&#47;epididimitis&#44; 5&#47;24 &#40;20&#44;83&#37;&#41; traumatismo testicular&#44; 3&#47;52 &#40;5&#44;77&#37;&#41; terapia previa con andr&#243;genos&#44; 1&#47;52 &#40;1&#44;92&#37;&#41; terapia previa con antiestr&#243;genos y 2&#47;52 &#40;3&#44;85&#37;&#41; tratamiento con antiandr&#243;genos&#46; Ning&#250;n paciente ten&#237;a antecedente de criptorquidia&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Once de 57 pacientes ten&#237;an laboratorio hormonal previo al diagn&#243;stico de c&#225;ncer de mama y los valores de los analitos fueron expresados en media y desviaci&#243;n est&#225;ndar &#40;x&#772;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#43;</span><span class="elsevierStyleHsp" style=""></span>SD&#41;&#58; testosterona total 2&#44;7<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#43;</span><span class="elsevierStyleHsp" style=""></span>1&#44;12<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#44; testosterona biodisponible 0&#44;78<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#43;</span><span class="elsevierStyleHsp" style=""></span>0&#44;63<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#44; testosterona libre 9&#44;6<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#43;</span><span class="elsevierStyleHsp" style=""></span>14&#44;44<span class="elsevierStyleHsp" style=""></span>pmol&#47;l&#44; estradiol 27&#44;43<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#43;</span><span class="elsevierStyleHsp" style=""></span>8&#44;63<span class="elsevierStyleHsp" style=""></span>pg&#47;ml&#44; FSH 7&#44;08<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#43;</span><span class="elsevierStyleHsp" style=""></span>19&#44;37<span class="elsevierStyleHsp" style=""></span>mU&#47;ml&#44; LH 4&#44;3<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#43;</span><span class="elsevierStyleHsp" style=""></span>10&#44;4<span class="elsevierStyleHsp" style=""></span>mU&#47;ml&#46; <span class="elsevierStyleItalic">El 63&#37; &#40;7&#47;11&#41;</span><span class="elsevierStyleItalic">present&#243; deficiencia de andr&#243;genos por laboratorio&#44; de los cuales el 45&#44;45&#37; &#40;5&#47;11&#41; ten&#237;a gonadotrofinas elevadas&#46;</span> No se encontraron diferencias significativas en la prevalencia de antecedentes androl&#243;gicos&#44; familiares y anatomopatol&#243;gicos entre el grupo con hipogonadismo hipergonadotr&#243;fico&#44; y el resto de los pacientes con deficiencia de andr&#243;genos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; <span class="elsevierStyleItalic">No se encontr&#243; ning&#250;n paciente con</span><span class="elsevierStyleItalic">diagn&#243;stico de s&#237;ndrome de Klinefelter&#44; aunque solo un paciente ten&#237;a cariotipo&#46;</span></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">La mediana de edad al momento del diagn&#243;stico fue de 71 a&#241;os RIC &#40;59-78&#41;&#46; En lo que respecta a las caracter&#237;sticas cl&#237;nicas antropom&#233;tricas de la poblaci&#243;n en estudio&#44; el 53&#44;06&#37; de los pacientes presentaba obesidad al momento del diagn&#243;stico y 13&#47;53 &#40;24&#44;53&#37;&#41; diabetes&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Diecis&#233;is de 29 pacientes &#40;55&#44;17&#37;&#41; ten&#237;an antecedentes familiares de c&#225;ncer de mama y 5 ten&#237;an estudiada la mutaci&#243;n del BRCA2&#44; de los cuales 2&#47;5 &#40;40&#37;&#41; fueron BRCA2 positivos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Uno de 56 &#40;1&#44;79&#37;&#41; pacientes ten&#237;a localizaci&#243;n del tumor bilateral&#46; El 80&#44;36&#37; &#40;45&#47;56&#41; de los pacientes se clasificaron como estadio <span class="elsevierStyleSmallCaps">i</span> seg&#250;n el TNM octava edici&#243;n&#44; 5&#47;56 &#40;8&#44;93&#37;&#41; estadio <span class="elsevierStyleSmallCaps">ii</span>&#44; ninguno estadio III y 6&#47;56 &#40;10&#44;71&#37;&#41; estadio <span class="elsevierStyleSmallCaps">iv</span>&#46; En lo que respecta a la histopatolog&#237;a del tumor 54&#47;56 &#40;96&#44;4&#37;&#41; fueron carcinomas ductales y 2&#47;56 &#40;3&#44;6&#37;&#41; carcinomas lobulillares&#46; El 96&#44;43&#37; ten&#237;a receptores hormonales positivos por inmunohistoqu&#237;mica &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">El tratamiento instituido fue quir&#250;rgico en 49&#47;56 &#40;87&#44;5&#37;&#41; de los pacientes&#44; radioterapia en 12&#47;55 &#40;21&#44;82&#37;&#41;&#44; quimioterapia en 9&#47;55 &#40;16&#44;36&#37;&#41; y hormonal en 47&#47;54 &#40;87&#44;04&#37;&#41;&#44; de los cuales el tamoxifeno se prescribi&#243; en 39&#47;54 &#40;72&#44;22&#37;&#41; pacientes&#44; inhibidores de la aromatasa en 14&#47;54 &#40;25&#44;93&#37;&#41; y an&#225;logos de la hormona liberadora de gonadotropina en 2&#47;54 &#40;3&#44;7&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0090" class="elsevierStylePara elsevierViewall">De acuerdo con el perfil gonadal identificamos que el 63&#37; presenta hipogonadismo&#44; de los cuales el 18&#37; &#40;2&#47;11&#41; es hipogonadotr&#243;fico y el 45&#44;45&#37; &#40;5&#47;11&#41; <span class="elsevierStyleItalic">hipergonadotr&#243;fico</span>&#46; Si bien est&#225; descrito en la literatura que el nivel de testosterona s&#233;rica disminuye gradualmente a partir de los 40 a&#241;os entre un 0&#44;4&#37; y 2&#44;6&#37; por a&#241;o&#44; la prevalencia de la deficiencia de andr&#243;genos es m&#225;xima a partir de la sexta d&#233;cada&#58; 16&#44;7&#37; entre 60-64 a&#241;os para la poblaci&#243;n de Hong Kong<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a>&#59; 18&#44;4&#37; en mayores de 70 a&#241;os para el <span class="elsevierStyleItalic">Massachussets Male Aging Study</span><a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a> y 17&#37; entre 40-79 a&#241;os para el <span class="elsevierStyleItalic">European Male Aging Study</span><a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a>&#46; En nuestro grupo la prevalencia de d&#233;ficit de testosterona &#40;63&#37;&#41; fue mayor a la reportada en poblaci&#243;n general&#44; probablemente influenciado por la mediana de edad de 71 a&#241;os&#46; Hasta la fecha no se han encontrado datos sobre la prevalencia de hipogonadismo hipergonadotr&#243;fico en la poblaci&#243;n general ni en los pacientes con CMM para cotejar con los resultados de nuestro estudio&#46; El proyecto de agrupaci&#243;n de c&#225;ncer de mama masculino mensur&#243; los niveles de estr&#243;genos y andr&#243;genos&#44; pero no de gonadotrofinas<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En cuanto a los antecedentes androl&#243;gicos encontramos mayor cantidad de pacientes con <span class="elsevierStyleItalic">infertilidad&#44; disfunci&#243;n sexual&#44; orquitis&#44; traumatismo testicular y terapia</span><span class="elsevierStyleItalic">previa con andr&#243;genos</span> en aquellos hombres con hipogonadismo hipergonadotr&#243;fico &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Se conoce que el desequilibrio hormonal y el aumento de los niveles de estr&#243;genos pueden conferir un mayor riesgo de desarrollar CMM<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#46; Estudios demuestran que la disfunci&#243;n y las anormalidades testiculares aumentan el riesgo de CMM&#46; Espec&#237;ficamente los antecedentes de&#58; criptorquidia&#44; orquitis&#44; hernia inguinal cong&#233;nita y orquiectom&#237;a pueden estar asociados con un mayor riesgo de c&#225;ncer de mama<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">6&#44;9</span></a>&#46; Todas estas son causas de hipogonadismo hipergonadotr&#243;fico&#44; lo cual permite sospechar que el aumento de las gonadotrofinas se asocie a un incremento de la relaci&#243;n estradiol&#47;testosterona por est&#237;mulo sobre la aromatasa de las c&#233;lulas de Leydig y Sertoli&#46; Durante d&#233;cadas se ha propuesto que el desequilibrio entre la relaci&#243;n de estr&#243;genos&#47;andr&#243;genos puede conducir a la proliferaci&#243;n de c&#233;lulas ductales&#44; lo que resulta en c&#225;ncer de mama invasivo<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a>&#46; Recientes publicaciones encuentran una fuerte asociaci&#243;n con niveles m&#225;s elevados de estradiol&#44; no as&#237; con la disminuci&#243;n de andr&#243;genos&#44; como se hab&#237;a especulado previamente<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A pesar de que se desconoce la prevalencia del hipogonadismo primario&#44; el <span class="elsevierStyleItalic">s&#237;ndrome de Klinefelter</span> &#40;SK&#41; cl&#225;sico &#40;cariotipo 47&#44; XXY&#41; es la causa m&#225;s com&#250;n de hipogonadismo cong&#233;nito y afecta a uno de cada 660 hombres&#46; Los mosaicismos &#40;46&#44; XY&#47;47&#44; XXY&#41; pueden presentarse en el 15&#37; al 20&#37; de los SK&#44; asoci&#225;ndose a un fenotipo m&#225;s leve&#44; y por ende tienden a subestimar la prevalencia real al no ser diagnosticados<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a>&#46; Se calcula que los hombres con SK tienen un riesgo de desarrollar CMM de 20 a 50 veces mayor que la poblaci&#243;n masculina general&#44; y algunos estudios estiman que hasta el 7&#37; de los hombres con CMM tienen diagn&#243;stico de s&#237;ndrome de Klinefelter<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">6&#44;14&#44;15</span></a>&#46; En nuestro estudio ning&#250;n paciente tiene diagn&#243;stico de SK&#44; pero solo en un hombre con hipogonadismo hipergonadotr&#243;fico se evalu&#243; el cariotipo&#44; pudiendo corresponder a un sesgo por subregistro cl&#237;nico&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Dentro del subgrupo de pacientes con hipogonadismo hipergonadotr&#243;fico se identificaron 2 hombres con antecedentes de c&#225;ncer prost&#225;tico previo al CMM&#44; ambos recibieron tratamiento quir&#250;rgico y radioterapia&#46; Thellenberg et al&#46; informan que el c&#225;ncer de pr&#243;stata aumenta 2 veces las probabilidades de padecer CMM y el riesgo se quintuplica cuando el c&#225;ncer de pr&#243;stata se diagnostica antes de los 60 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La <span class="elsevierStyleItalic">ginecomastia</span> est&#225; presente en el 29&#44;17&#37; de los hombres de nuestra poblaci&#243;n con c&#225;ncer de mama&#46; Tanto la ginecomastia como la obesidad se asocian al riesgo de CMM probablemente en forma independiente&#46; La ginecomastia vinculada al exceso de estr&#243;genos podr&#237;a aumentar el riesgo de desarrollar CMM&#59; sin embargo&#44; no est&#225; claro si la ginecomastia es un factor de riesgo independiente para desarrollar CMM o si ambas enfermedades tienen similares factores de riesgo<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Esto avalar&#237;a que niveles elevados de estr&#243;genos podr&#237;an ser un biomarcador de riesgo aun en ausencia de ginecomastia diagnosticada<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a>&#46; Otros autores han reportado que la presencia de ginecomastia duplica el riesgo de CMM&#44; sin embargo&#44; este factor de riesgo no fue estad&#237;sticamente significativo y podr&#237;a representar solo una peque&#241;a proporci&#243;n de todos los casos<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En nuestro grupo de estudio la mediana de edad en el momento del diagn&#243;stico del CMM fue de 71 a&#241;os&#44; en l&#237;nea con la literatura publicada&#59; el carcinoma de mama en hombres se presenta a una edad posterior &#40;5 a 10 a&#241;os&#41; a su par femenino&#46; Reportes de diferentes cohortes se&#241;alan edades promedio al diagn&#243;stico de 65&#44;5<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleBold">&#44;</span> 67<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">2</span></a> y 68 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El 53&#44;06&#37; de los pacientes incluidos en el estudio presenta obesidad&#44; valor comparativamente superior a los datos publicados en la cuarta Encuesta Nacional de Factores de Riesgo del a&#241;o 2019&#44; donde la prevalencia de obesidad en la regi&#243;n era del 33&#44;9&#37;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Los <span class="elsevierStyleItalic">antecedentes familiares de c&#225;ncer de mama</span> confieren de 2 a 3 veces mayor riesgo de desarrollar CMM&#46; El 20&#37; de los hombres con CMM tienen al menos una pariente femenina de primer grado con c&#225;ncer de mama y el riesgo aumenta con un mayor n&#250;mero de familiares afectados<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a>&#46; La <span class="elsevierStyleItalic">mutaci&#243;n BRCA2</span> es un factor causal claro para el CMM&#46; El 4&#37; al 15&#37; de los CMM presentan mutaciones BRCA2 delet&#233;reas&#44; y del 5&#37; al 10&#37; de los portadores BRCA2 desarrollan CMM&#46; La mutaci&#243;n se asocia a una enfermedad m&#225;s temprana y m&#225;s agresiva<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a>&#46; Tambi&#233;n se ha vinculado con un aumento en la incidencia de otros c&#225;nceres&#44; como p&#225;ncreas&#44; pr&#243;stata&#44; melanoma y colorrectal<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En nuestro trabajo el 55&#44;17&#37; de los pacientes tiene antecedentes familiares de c&#225;ncer de mama&#46; Recabamos el dato del estudio gen&#233;tico para BRCA2 en 5 pacientes del total de la muestra y solo 2 resultaron ser portadores de la mutaci&#243;n BRCA2 &#40;el 40&#37; de los estudiados para la mutaci&#243;n&#41;&#44; que coincidentemente refieren antecedentes familiares&#46; Sin embargo&#44; al momento del diagn&#243;stico presentaban edad avanzada y estadios tempranos de enfermedad&#44; contrario a lo que se menciona en la literatura&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En cuanto a otras comorbilidades asociadas en nuestra poblaci&#243;n la m&#225;s preponderante es la diabetes&#44; presente en el 24&#44;53&#37; de los pacientes con CMM&#44; a diferencia de los datos publicados en la cuarta Encuesta Nacional de Factores de Riesgo<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a>&#44; donde la prevalencia de glucemia elevada&#47;diabetes en la poblaci&#243;n Argentina adulta es del 12&#44;7&#37;&#46; Si bien no se estim&#243; la prevalencia de diabetes en el &#250;ltimo an&#225;lisis de situaci&#243;n de salud por c&#225;ncer<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a>&#44; se establece una relaci&#243;n directa entre c&#225;ncer y los factores de riesgo para presentar diabetes &#40;sobrepeso&#44; obesidad&#44; sedentarismo&#44; tabaquismo&#44; consumo de alcohol y bajo consumo de frutas y verduras&#41;&#44; conforme a lo que observamos en los pacientes con CMM&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Por otra parte&#44; la osteoporosis&#44; hepatopat&#237;a e hipertiroidismo se presentan en menor medida &#40;20&#37;&#44; 2&#44;7&#37; y 4&#37; respectivamente&#41;&#46; Af&#237;n a lo publicado&#44; Brinton et al&#46; no observan relaci&#243;n de riesgo con enfermedades hep&#225;ticas o tiroideas&#44; que se hab&#237;a descrito en publicaciones previas&#44; donde se encontr&#243; riesgo elevado&#44; aunque no significativo&#44; para hipertiroidismo y cirrosis hep&#225;tica<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">8&#44;21</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Si bien datos anteriores han sugerido que el CMM tiende a presentarse en una etapa m&#225;s avanzada<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">22&#44;23</span></a>&#44; un estudio reciente informa de que el 73&#37; de los pacientes con CMM &#40;excluyendo el carcinoma <span class="elsevierStyleItalic">in situ</span>&#41; ten&#237;an enfermedad en estadio <span class="elsevierStyleSmallCaps">i</span> o <span class="elsevierStyleSmallCaps">ii</span>&#40;seg&#250;n TNM octava edici&#243;n<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a>&#41;&#44; y un n&#250;mero limitado de casos ten&#237;a afectaci&#243;n ganglionar extensa en el momento del diagn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a>&#46; Esto est&#225; en concordancia con nuestros resultados&#44; donde la mayor&#237;a de los pacientes presentaban estadios tempranos de la enfermedad &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En cuanto a la histopatolog&#237;a del tumor los carcinomas ductales y papilares son los histotipos m&#225;s frecuentes&#46; Tambi&#233;n encontramos elevada prevalencia de positividad del receptor hormonal en CMM&#44; lo que es consistente con los datos publicados<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Si bien no se encontraron diferencias significativas en antecedentes androl&#243;gicos&#44; antecedentes familiares&#44; estadio del CMM ni tratamiento instituido entre el grupo de pacientes con hipogonadismo hipergonadotr&#243;fico y aquellos con hipogonadismo hipo&#47;normogonadotr&#243;fico&#44; no se descarta que el resultado pueda estar influenciado por el bajo &#171;n&#187; del estudio&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La principal limitaci&#243;n del estudio fue el dise&#241;o retrospectivo&#44; con datos faltantes en el registro de la historia cl&#237;nica electr&#243;nica&#44; pero que se intent&#243; compensar con la encuesta estructurada por v&#237;a telef&#243;nica realizada por la investigadora principal&#46; Si bien el estudio se llev&#243; a cabo en un solo centro&#44; es un hospital de referencia y derivaci&#243;n&#44; y esto podr&#237;a representar hasta cierto punto a la poblaci&#243;n argentina&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">La mayor fortaleza de este trabajo es la cantidad de pacientes con c&#225;ncer de mama masculino estudiados en la regi&#243;n&#44; ya que se desconocen datos en Argentina&#46; Adem&#225;s&#44; es el &#250;nico trabajo que evalu&#243; la presencia de hipogonadismo hipergonadotr&#243;fico en los pacientes con CMM&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusi&#243;n</span><p id="par0175" class="elsevierStylePara elsevierViewall">El desequilibrio hormonal y un mayor nivel de estr&#243;genos pueden conferir un aumento del riesgo de desarrollar c&#225;ncer de mama masculino&#46; Identificamos similitudes con la literatura publicada acerca de la prevalencia de ciertos factores de riesgo antropom&#233;tricos y hormonales&#44; como la obesidad&#44; la diabetes y la infertilidad en el desarrollo del CMM&#46; Por otra parte&#44; en nuestro grupo la prevalencia de d&#233;ficit de testosterona fue mayor a la reportada en la poblaci&#243;n general&#46; Muchos de estos factores de riesgo respaldan la necesidad de explorar el papel de las hormonas end&#243;genas&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Los estudios epidemiol&#243;gicos del c&#225;ncer de mama masculino son poco frecuentes y&#44; hasta la fecha&#44; la mayor&#237;a han sido estudios peque&#241;os de casos y controles&#44; lo que aumenta la posibilidad de que los factores de riesgo puedan reflejar la influencia del azar o los sesgos de selecci&#243;n y recuerdo&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Debido a la baja incidencia y a la investigaci&#243;n limitada sobre la enfermedad&#44; delinear los factores causales del c&#225;ncer de mama masculino sigue siendo un desaf&#237;o&#46; Son necesarios nuevos estudios que aporten informaci&#243;n respecto a la epidemiolog&#237;a del c&#225;ncer de mama masculino para ayudar a los m&#233;dicos a atender y aconsejar a los hombres con mayor riesgo de esta enfermedad&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0190" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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        3 => array:3 [
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          "titulo" => "Abstract"
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              "titulo" => "Introduction"
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          "titulo" => "Conflicto de intereses"
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    "fechaRecibido" => "2021-10-28"
    "fechaAceptado" => "2022-02-08"
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            0 => "Ginecomastia&#44; S&#237;ndrome Klinefelter&#44; Hipogonadismo hipergonadotr&#243;fico&#44; D&#233;ficit de testosterona&#44; Infertilidad&#44; Disfunci&#243;n sexual"
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            0 => "CMM"
            1 => "GnRH"
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            0 => "Gynaecomastia"
            1 => "Klinefelter syndrome"
            2 => "Hypergonadotropic hypogonadism"
            3 => "Testosterone deficiency"
            4 => "Infertility"
            5 => "Sexual dysfunction"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El carcinoma de mama masculino &#40;CMM&#41; es una enfermedad poco frecuente&#44; ya que representa menos del 0&#44;5&#37; de los diagn&#243;sticos de c&#225;ncer en el hombre&#46; Se desconocen los datos de prevalencia en Argentina&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo primario</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estimar la prevalencia de antecedentes androl&#243;gicos asociados a CMM&#44; as&#237; como las caracter&#237;sticas antropom&#233;tricas y cl&#237;nicas de la poblaci&#243;n estudiada&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio de corte transversal que incluy&#243; a todos los hombres seg&#250;n su sexo biol&#243;gico original&#44; mayores de 18 a&#241;os&#44; con antecedente de c&#225;ncer de mama&#44; que consultaron en el Hospital Italiano de Buenos Aires entre enero de 2010 y diciembre de 2018&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Incluimos a 57 hombres con c&#225;ncer de mama&#46; La mediana de edad fue de 71 a&#241;os&#46; El 53&#44;06&#37; present&#243; obesidad y 24&#44;53&#37; diabetes&#46; Respecto a los antecedentes androl&#243;gicos el 5&#44;56&#37; &#40;2&#47;36&#41; ten&#237;a infertilidad&#44; el 29&#44;17&#37; &#40;14&#47;48&#41; ginecomastia y el 60&#44;71&#37; &#40;17&#47;28&#41; disfunci&#243;n sexual&#46; <span class="elsevierStyleItalic">El 63&#37; &#40;7&#47;11&#41; present&#243; deficiencia</span><span class="elsevierStyleItalic">de andr&#243;genos por laboratorio&#44; de los cuales el 45&#44;45&#37; &#40;5&#47;11&#41; ten&#237;a gonadotrofinas elevadas&#46;</span></p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusi&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Identificamos similitudes con la literatura acerca de la prevalencia de obesidad&#44; diabetes e infertilidad en pacientes con CMM&#46; La prevalencia de d&#233;ficit de testosterona fue mayor a la reportada para hombres de la misma edad&#46; Muchos de estos factores respaldan la necesidad de explorar el papel de las hormonas end&#243;genas&#46; Se requiere m&#225;s investigaci&#243;n para ayudar a los m&#233;dicos a atender y aconsejar a los hombres con mayor riesgo de esta enfermedad&#46;</p></span>"
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            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivo primario"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
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          3 => array:2 [
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            "titulo" => "Resultados"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Male breast carcinoma &#40;MBC&#41; is an uncommon disease&#44; accounting for less than 0&#46;5&#37; of cancer diagnoses in men&#46; Data on the prevalence thereof in Argentina are unknown&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Primary objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To estimate the prevalence of a men&#39;s health history associated with MBC as well as the anthropometric and clinical characteristics of the study population&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">This cross-sectional study included all men according to original biological sex over 18 years of age with a history of breast cancer who sought care at the Hospital Italiano de Buenos Aires &#91;Italian Hospital of Buenos Aires&#93; between January 2010 and December 2018&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We included 57 men with breast cancer&#46; Their median age was 71 years&#46; Of them&#44; 53&#46;06&#37; had obesity and 24&#46;53&#37; had diabetes&#46; With respect to men&#39;s health history&#44; 5&#46;56&#37; &#40;2&#47;36&#41; had infertility&#44; 29&#46;17&#37; &#40;14&#47;48&#41; had gynaecomastia and 60&#46;71&#37; &#40;17&#47;28&#41; had sexual dysfunction&#46; <span class="elsevierStyleItalic">Some 63&#37; &#40;7&#47;11&#41; had androgen deficiency based on laboratory diagnosis&#59; of them&#44; 45&#46;45&#37; &#40;5&#47;11&#41; had high gonadotropins&#46;</span></p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">We identified similarities with the literature as to the prevalence of obesity&#44; diabetes and infertility in patients with MBC&#46; The prevalence of testosterone deficiency was higher than reported for men of the same age&#46; Many of these factors support the need to examine the role of endogenous hormones&#46; Further research is required to help physicians care for and counsel men at higher risk of this disease&#46;</p></span>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">De acuerdo al perfil hormonal&#44; se identificaron 3 categor&#237;as de pacientes&#58; con hipogonadismo hipergonadotr&#243;fico&#44; sin hipogonadismo hipergonadotr&#243;fico y aquellos que no registraban laboratorio hormonal en la historia cl&#237;nica electr&#243;nica&#46; Se compararon variables demogr&#225;ficas&#44; antecedentes androl&#243;gicos&#44; antecedentes familiares&#44; estadio de la enfermedad seg&#250;n en TNM 8&#46;&#170; edici&#243;n y el tratamiento recibido&#46; A&#46; androl&#243;gicos&#58; antecedentes androl&#243;gicos&#59; A&#46; familiares&#58; antecedentes familiares&#59; C&#46; demogr&#225;ficas&#58; caracter&#237;sticas demogr&#225;ficas&#59; FA&#58; frecuencia absoluta &#40;destacado en negrita&#41;&#59; IMC&#58; &#237;ndice de masa corporal&#59; Me&#58; mediana&#59; NR&#58; no registro&#59; RIC&#58; rango intercuart&#237;lico&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">FA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Me&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;00&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 25300164
Idioma original: Español
DOI:10.1016/j.endinu.2022.02.003
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