Doyle John J, Neugut Alfred I, Jacobson Judith S, Wang Jian, McBride Russell, Grann Alison, Grann Victor R, Hershman Dawn
Department of Epidemiology, Mailman School of Public, College of Physicians and Surgeons, Columbia University, New York Presbyterian Hospital, New York, NY, USA.
Int J Radiat Oncol Biol Phys. 2007 May 1;68(1):82-93. doi: 10.1016/j.ijrobp.2006.12.019. Epub 2007 Mar 2.
The benefits of adjuvant radiation therapy (RT) for breast cancer may be counterbalanced by the risk of cardiac toxicity. We studied the cardiac effects of RT and the impact of pre-existing cardiac risk factors (CRFs) in a population-based sample of older patients with breast cancer.
In the Surveillance, Epidemiology and End-Results (SEER)-Medicare database of women > or = 65 years diagnosed with Stages I to III breast cancer from January 1, 1992 to December 31, 2000, we used multivariable logistic regression to model the associations of demographic and clinical variables with postmastectomy and postlumpectomy RT. Using Cox proportional hazards regression, we then modeled the association between treatment and myocardial infarction (MI) and ischemia in the 10 or more years after diagnosis, taking the predictors of treatment into account.
Among 48,353 women with breast cancer; 19,897 (42%) were treated with lumpectomy and 26,534 (55%) with mastectomy; the remainder had unknown surgery type (3%). Receipt of RT was associated with later year of diagnosis, younger age, fewer comorbidities, nonrural residence, and chemotherapy. Postlumpectomy RT was also associated with white ethnicity and no prior history of heart disease (HD). The RT did not increase the risk of MI. Presence of MI was associated with age, African American ethnicity, advanced stage, nonrural residence, more than one comorbid condition, a hormone receptor-negative tumor, CRFs and HD. Among patients who received RT, tumor laterality was not associated with MI outcome. The effect of RT on the heart was not influenced by HD or CRFs.
It appears unlikely that RT would increase the risk of MI in elderly women with breast cancer, regardless of type of surgery, tumor laterality, or history of CRFs or HD, for at least 10 years.
辅助性放射治疗（RT）对乳腺癌的益处可能会被心脏毒性风险所抵消。我们在一个基于人群的老年乳腺癌患者样本中研究了RT对心脏的影响以及既往存在的心脏危险因素（CRF）的影响。
在监测、流行病学与最终结果（SEER）-医疗保险数据库中，选取1992年1月1日至2000年12月31日期间诊断为I至III期乳腺癌的65岁及以上女性，我们使用多变量逻辑回归对人口统计学和临床变量与乳房切除术后和保乳切除术后RT的关联进行建模。然后，我们使用Cox比例风险回归，在考虑治疗预测因素的情况下，对诊断后10年或更长时间内治疗与心肌梗死（MI）和局部缺血之间的关联进行建模。
在48353例乳腺癌女性中，19897例（42%）接受了保乳切除术，26534例（55%）接受了乳房切除术；其余患者手术类型未知（3%）。接受RT与诊断年份较晚、年龄较小、合并症较少、非农村居住以及化疗有关。保乳切除术后RT还与白人种族和无心脏病（HD）既往史有关。RT并未增加MI的风险。MI的存在与年龄、非裔美国人种族、晚期、非农村居住、一种以上合并症、激素受体阴性肿瘤、CRF和HD有关。在接受RT的患者中，肿瘤的侧别与MI结局无关。RT对心脏的影响不受HD或CRF的影响。
至少在10年内，无论手术类型、肿瘤侧别或CRF或HD病史如何，RT似乎不太可能增加老年乳腺癌女性发生MI的风险。
