Search

Additional file 2.

Additional file 6.

Additional file 4.

Additional file 3.

Additional file 1.

Additional file 5.

Additional file 14: Figure S12. Kaplan–Meier curves for disease-free survival according to change of PNI by clinical stage and HG. PNI: Prognostic nutritional index, HG: Histological grade.

Additional file 5: Figure S3. Disease-free survival evaluated using the Kaplan–Meier method for Alb, NLR, and BMI at post-NAC. NAC: Neoadjuvant chemotherapy, Alb: Serum albumin level (g/dl), NLR: Neutrophil/lymphocyte ratio, BMI: Body mass index.

Additional file 3: Table S2. The AUC and sensitivity/specificity for ROC curve.

Additional file 2: Table S1. Distribution of patients with decreased PNI, Alb, and BMI or increased NLR during NAC.

Additional file 9: Figure S7. Kaplan–Meier curves for disease-specific survival according to change in Alb, NLR, and BMI. Alb: Serum albumin level (g/dl), NLR: Neutrophil/lymphocyte ratio, BMI: Body mass index.

Additional file 4: Figure S2. Disease-free survival evaluated using the Kaplan–Meier method for Alb, NLR, and BMI at pre-NAC. NAC: Neoadjuvant chemotherapy, Alb: Serum albumin level (g/dl), NLR: Neutrophil/lymphocyte ratio, BMI: Body mass index.

Additional file 7: Figure S5. Disease-specific survival evaluated using the Kaplan–Meier method according to change of PNI value. PNI: Prognostic nutritional index.

Additional file 8: Figure S6. Kaplan–Meier curves for disease-free survival according to change in Alb, NLR, and BMI. Alb: Serum albumin level (g/dl), NLR: Neutrophil/lymphocyte ratio, BMI: Body mass index.

Takaaki Oba,1 Mayu Ono,1 Asumi Iesato,1 Toru Hanamura,1 Takayuki Watanabe,1 Tokiko Ito,1 Toshiharu Kanai,1 Kazuma Maeno,1 Ken-ichi Ito,1 Ayako Tateishi,2 Akihiko Yoshizawa,2 Fumiyoshi Takayama31Division of Breast, Endocrine and Respiratory Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, 2Department of Laboratory Medicine, Shinshu University Hospital, 3Imaging Center, Ichinose Neurosurgical Hospital, Matsumoto, JapanAbstract: Lipid-rich carcinoma (LRC) of the breast is a rare breast cancer variant that accounts for

Mayu Ono, Tokiko Ito, Toshiharu Kanai, Koichi Murayama, Hiroshi Koyama, Kazuma Maeno, Yasuhiro Mochizuki, Asumi Iesato, Toru Hanamura, Toshihiro Okada, Takayuki Watanabe, Ken-ichi ItoDivision of Breast and Endocrine Surgery, Department of Surgery (II), Shinshu University School of Medicine, Matsumoto, JapanAbstract: Bevacizumab when combined with chemotherapy exerts significant activity against many solid tumors through tumor angiogenesis inhibition; however, it can induce severe side effects. We report the rare case of a 27-year-old premenopausal woman with locally advanced breast cancer that was marked by rapid tumor necrosis followed by massive hemorrhage shortly after bevacizumab and paclitaxel administration. On the basis of histopathological examination of a biopsy specimen and computed tomography findings, she was diagnosed with stage IV estrogen and progesterone receptor-negative and human epidermal growth factor receptor type 2-positive breast cancer with multiple organ metastases when she had entered gestational week 24. Cyclophosphamide, Adriamycin®, fluorouracil therapy was initiated, but multiple liver metastases continued to progress. A healthy fetus was delivered by induced delivery and trastuzumab-based treatment was initiated. Although the multiple liver metastases were controlled successfully by trastuzumab combined with paclitaxel, the primary tumor continued to expand even after subsequent administration of three other treatment regimens including anti-human epidermal growth factor receptor type 2 agents and cytotoxic drugs. To inhibit primary tumor growth, a combination therapy with paclitaxel and bevacizumab was subsequently initiated. Following therapy initiation, however, the large tumor occupying the patient's entire left breast became necrotic and ulcerated rapidly. Furthermore, massive hemorrhage from the tumor occurred 5 weeks after bevacizumab-based therapy initiation. Although hemostasis was achieved by manual compression, the patient required blood transfusion for the massive blood loss. She eventually succumbed to respiratory failure. This case report demonstrates that primary breast cancer lesions with skin involvement have the potential to cause massive hemorrhage after bevacizumab-based treatment.Keywords: bevacizumab, breast cancer, necrosis, hemorrhage, adverse event, paclitaxel