ObjectiveBreast cancer visceral crisis (VC) is caused by excessive tumor burden leading to severe organ dysfunction with poor prognosis. Traditional chemotherapy reduces the quality of life of patients without significantly improving survival. The aim of this study was to investigate the clinical characteristics of patients with VC and the prognosis by using different treatment options.MethodsAccording to the 5th European School of Oncology (ESO)–European Society for Medical Oncology (ESMO) international consensus guidelines for advanced breast cancer guidelines (ABC 5), patients who were treated in the First Hospital of Jilin University from 2018 to 2022 and diagnosed with breast cancer VC were retrospectively analyzed. The analysis focused on the characteristics of the patients, the treatment regimens, and prognosis.ResultsA total of 133 patients were included in this study. As for metastasis breast cancer subtype, 92 (69.18%) were hormone receptor (HR) positive, human epidermal growth factor receptor 2 (HER-2) negative, 20 (15.04%) had HER-2 overexpression, and 21 (15.78%) were triple negative. All patients had an mOS of 11.2 months (range, 1.1–107.8 months). In different types of VC, the median overall survival (mOS) of bone marrow metastasis (BMM) was 18.0 months (range, 2.0–107.8 months), that of diffuse liver metastasis (DLM) was 8.1 months (range, 1.3–30.2 months), and that of meningeal metastasis (MM) was 9.0 months (range, 1.2–53.8 months). In 92 HR+, Her-2− patients using different treatment regimens, mOS was 6.2 months (range, 1.2–29.8 months) in the chemotherapy group while it was 24.3 months (range, 3.1–107.8 months) in the endocrine therapy (ET) group. Multivariate Cox regression analysis suggested that Eastern Cooperative Oncology Group (ECOG) scores and type of VC were associated with survival.ConclusionPrognosis varied in different types of VC. Patients with BMM had the best prognosis, and DLM had the worst. As treatment options continue to progress, our retrospective study showed a significant prolongation of overall survival (OS) in patients with VC compared to previous studies.
ObjectiveBreast cancer symptomatic bone marrow metastasis (BMM) is rare and has a poor prognosis. Chemotherapy is usually the primary treatment, but it has limited efficacy, resulting in dose reduction and a decrease in quality of life due to the adverse effects of the agent. Other than chemotherapy, there are no other treatment studies for BMM. This study aimed to explore the clinicopathological characteristics of BMM patients with breast cancer, the prognosis using different treatment modalities, and the risk factors that affect the prognosis.MethodsThis retrospective study included patients diagnosed with breast cancer BMM from January 2018 to January 2022 in the Cancer Center of the First Hospital of Jilin University. The analysis focused on the characteristics of the patients, the treatment regimen, and the prognosis.ResultsOf 733 patients with advanced breast cancer, 33 patients were identified with BMM. All patients showed a hemoglobin decrease, and 25 (75.75%) presented with a fever of unknown origin. As for the metastasis breast cancer subtype, 25 (75.75%) were hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) negative, three (9.09%) had HER2 overexpression, and five (15.15%) were triple negative. The BMM patients had a median progression-free survival (PFS) of 7 months (1–21 months) and a median overall survival (OS) of 18 months (2–108 months). Among 25 HR+/HER2− BMM patients treated with different modalities, the median OS of the endocrine therapy (ET) group was 23 months, compared with 5 months in the chemotherapy group. Cox proportional hazards models suggested that higher Eastern Cooperative Oncology Group (ECOG) scores and old age were associated with shorter survival.ConclusionWhen breast cancer patients present with anemia and fever of unknown origin, BMM should be considered. For HR+/HER2− patients with good physical status and can receive active treatment, CDK4/6 inhibitors combined with ET can be used to control disease progression, improve quality of life, and prolong survival.
Fibrinolysis is a bleeding disorder characterized by hypofibrinogenemia caused by abnormal activation of fibrinolytic system function. Patients with cancer are prone to hypercoagulable and should be vigilant for the risk of venous thrombosis. However, patients with tumors in which bleeding is the first manifestation are relatively rare. The present study reports the case of a 52-year-old woman with metastatic breast cancer with acquired hyperfibrinolysis as the first manifestation. Hyperfibrinolysis is an important sign and manifestation of disease progression. In this case, fibrinogen was used as a sensitive biomarker of tumor burden to specifically predict the efficacy of the antitumor therapy. Effective antitumor therapy can improve the hyperfibrinolysis of patients, and so the fibrinogen levels gradually increased. In conclusion, the present case showed acquired hyperfibrinolysis with bleeding symptoms, which is an uncommon paraneoplastic phenomenon in breast cancer, especially when combined with bone marrow metastasis, as in the present case. Timely diagnosis and treatment of the primary disease is the fundamental way to improve hyperfibrinolysis. As an effective biomarker, fibrinogen level predicts the changes in a patient's illness and guides the clinical diagnosis and treatment process.
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