乳腺癌辅助放疗后心脏死亡风险
Risk of cardiac death after adjuvant radiotherapy for breast cancer.
作者信息
Giordano Sharon H, Kuo Yong-Fang, Freeman Jean L, Buchholz Thomas A, Hortobagyi Gabriel N, Goodwin James S
机构信息
Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe, Box 424, Houston, TX 77030, USA.
出版信息
J Natl Cancer Inst. 2005 Mar 16;97(6):419-24. doi: 10.1093/jnci/dji067.
BACKGROUND
Women with breast cancer who are treated with adjuvant radiation have a decreased risk of local recurrence but an increased risk of mortality from ischemic heart disease. Patients with left-sided breast tumors receive a higher dose of radiation to the heart than patients with right-sided tumors. Because radiation techniques have improved over time, we investigated whether the risk of death from ischemic heart disease after adjuvant breast radiotherapy decreased over time.
METHODS
We used the 12-registry 1973-2000 dataset from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Women (n = 27,283) treated with adjuvant radiation for breast cancer diagnosed in 1973-1989 were included in the study. Ischemic heart disease mortality was calculated at 15 years and compared for women diagnosed during 1973-1979, 1980-1984, and 1985-1989. Cox proportional hazards models were used to calculate the hazard of death from ischemic heart disease for women diagnosed 1973-1988 and censored at 12 years. All statistical tests were two-sided.
RESULTS
There were no differences in age, race/ethnicity, disease stage, or follow-up time between the 13 998 women with left-sided and 13 285 with right-sided cancer. For women diagnosed in 1973-1979, there was a statistically significant difference in 15-year mortality from ischemic heart disease between patients with left-sided (13.1%, 95% confidence interval [CI] = 11.6 to 14.6) and those with right-sided (10.2%, 95% CI = 8.9 to 11.5) breast cancer (P = .02); no such difference was found for women diagnosed in 1980-1984 (9.4%, [95% CI = 8.1 to 10.6] versus 8.7% [95% CI = 7.4 to 10.0], respectively, P = .64) or 1985-1989 (5.8% [95% CI = 4.8 to 6.8] versus 5.2% [95% CI = 4.4 to 5.9], respectively, P = .98). In the Cox model, the hazard ratio [HR] for ischemic heart disease mortality for women with left-sided versus women with right-sided disease was 1.50 (95% CI = 1.19 to 1.87) in 1979. With each succeeding year after 1979, the hazard of death from ischemic heart disease for women with left-sided versus those with right-sided disease declined by 6% (HR = 0.94, 95% CI = 0.91 to 0.98).
CONCLUSIONS
Risk of death from ischemic heart disease associated with radiation for breast cancer has substantially decreased over time.
背景
接受辅助放疗的乳腺癌女性局部复发风险降低，但缺血性心脏病导致的死亡风险增加。左侧乳腺肿瘤患者心脏接受的辐射剂量高于右侧肿瘤患者。由于放疗技术随时间推移有所改进，我们调查了辅助性乳腺癌放疗后缺血性心脏病死亡风险是否随时间降低。
方法
我们使用了美国国立癌症研究所监测、流行病学和最终结果（SEER）计划的12个登记处1973 - 2000年数据集。纳入了1973 - 1989年确诊为乳腺癌并接受辅助放疗的女性（n = 27283）。计算15年时的缺血性心脏病死亡率，并对1973 - 1979年、1980 - 1984年和1985 - 1989年确诊的女性进行比较。采用Cox比例风险模型计算1973 - 1988年确诊并在12年时进行随访的女性因缺血性心脏病死亡的风险。所有统计检验均为双侧检验。
结果
13998例左侧乳腺癌女性和13285例右侧乳腺癌女性在年龄、种族/民族、疾病分期或随访时间方面无差异。对于1973 - 1979年确诊的女性，左侧乳腺癌患者（13.1%，95%置信区间[CI] = 11.6至14.6）和右侧乳腺癌患者（10.2%，95%CI = 8.9至11.5）的15年缺血性心脏病死亡率存在统计学显著差异（P = 0.02）；1980 - 1984年确诊的女性未发现此类差异（分别为9.4%，[95%CI = 8.1至10.6]和8.7%[95%CI = 7.4至10.], P = 0.64）或1985 - 1989年确诊的女性（分别为5.8%[95%CI = 4.8至6.8]和5.2%[95%CI = 4.4至5.9]，P = 0.98）。在Cox模型中，1979年左侧疾病女性与右侧疾病女性因缺血性心脏病死亡的风险比[HR]为1.50（95%CI = 1.19至1.87）。在1979年后的每一年，左侧疾病女性与右侧疾病女性因缺血性心脏病死亡的风险每年下降6%（HR = 0.94，95%CI = 0.91至0.98）。
结论
与乳腺癌放疗相关的缺血性心脏病死亡风险随时间大幅降低。
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