Advances in medical sciences · 2026
Bone marrow involvement in breast cancer: a retrospective cohort study.
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Sigorski Dawid, Wilk Michał, Michalak Maciej, Pieniuk-Faszyńska Katarzyna, Kozielec Zygmunt, Lewandowski Tomasz, Lebiedzińska Aneta
Аннотация
PURPOSE: The incidence of bone marrow metastases is a rarely described manifestation of metastatic breast cancer (BC).
MATERIAL AND METHODS: Clinical, laboratory and histopathological data were retrospectively analyzed in 50 women with histopathologically confirmed BC metastasis.
RESULTS: The median age was 68.3 years, and 60% of patients had an ECOG performance status of 0-1. Most cases were BC of no special type (n = 47; 94%), primary in 70% (n = 35). The luminal Human Epidermal Growth Factor Receptor 2 (HER2) - was the predominant biological subtype (n = 35; 70%). The most common indications for trephine biopsy were anemia and thrombocytopenia. Synchronous bone metastases occurred in most patients. Biological type 4conversion was seen in 16 cases (32%) and included luminal converting into triple negative BC (n = 6; 37.5%) and luminal HER2+ into luminal HER2- BC (n = 3; 18.75%). The median of overall survival (OS) was 9.2 months (95% CI: 6.3 - 14.9). High lactate dehydrogenase level (p = 0.023) and thrombocytopenia (p < 0.001) correlated with a shorter median OS. In multivariate analysis, low levels of platelets correlated with a lower median OS (p < 0.001). A positive correlation occurred between lymphocytes (p < 0.001), monocytes (p < 0.001) and the percentage of bone marrow infiltration. Higher neutrophil-to-lymphocyte ratio was associated with shorter survival (p = 0.02).
CONCLUSIONS: Bone marrow metastases indicate a poor prognosis. The high rate of receptor conversion highlights the importance of re-evaluating tumor biology after BC progression which may increase the scope of systemic treatment options and improve the prognosis.
MATERIAL AND METHODS: Clinical, laboratory and histopathological data were retrospectively analyzed in 50 women with histopathologically confirmed BC metastasis.
RESULTS: The median age was 68.3 years, and 60% of patients had an ECOG performance status of 0-1. Most cases were BC of no special type (n = 47; 94%), primary in 70% (n = 35). The luminal Human Epidermal Growth Factor Receptor 2 (HER2) - was the predominant biological subtype (n = 35; 70%). The most common indications for trephine biopsy were anemia and thrombocytopenia. Synchronous bone metastases occurred in most patients. Biological type 4conversion was seen in 16 cases (32%) and included luminal converting into triple negative BC (n = 6; 37.5%) and luminal HER2+ into luminal HER2- BC (n = 3; 18.75%). The median of overall survival (OS) was 9.2 months (95% CI: 6.3 - 14.9). High lactate dehydrogenase level (p = 0.023) and thrombocytopenia (p < 0.001) correlated with a shorter median OS. In multivariate analysis, low levels of platelets correlated with a lower median OS (p < 0.001). A positive correlation occurred between lymphocytes (p < 0.001), monocytes (p < 0.001) and the percentage of bone marrow infiltration. Higher neutrophil-to-lymphocyte ratio was associated with shorter survival (p = 0.02).
CONCLUSIONS: Bone marrow metastases indicate a poor prognosis. The high rate of receptor conversion highlights the importance of re-evaluating tumor biology after BC progression which may increase the scope of systemic treatment options and improve the prognosis.