Vigo Chiara, Gatzemeier Wolfgang, Sala Roberto, Malacarne Mara, Santoro Armando, Pagani Massimo, Lucini Daniela
BIOMETRA Department, University of Milan, Milan, Italy.
Exercise Medicine Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni, Rozzano, 56, 20089, Milan, Italy.
J Cancer Surviv. 2015 Dec;9(4):699-706. doi: 10.1007/s11764-015-0445-z. Epub 2015 Apr 22.
Surgery and adjuvant therapy improved prognosis of breast cancer survivors. This improvement risks being offset by potential late-occurring cardiovascular toxicity of oncologic treatment and increased cardiometabolic risk profile associated with lifestyle changes. We address the hypothesis that in breast cancer survivors, multiple functional alterations might define a phenotype, characterized by vagal impairment, diminished aerobic fitness, increased metabolic risk, and reduced wellbeing.
We studied 171 sedentary asymptomatic women (106 cancer survivor-65 controls) of similar age (53 ± 8.6; 51 ± 8.1 years). Autonomic regulation was evaluated by autoregressive spectral analysis of R wave to R wave (RR) interval and systolic arterial pressure variability. Aerobic fitness was directly assessed by cardiopulmonary exercise test. Body mass index (BMI) and waist circumference served as proxies of metabolism. Fatigue and stress-related symptoms were evaluated with validated questionnaire.
Patients showed significantly smaller total RR variance (1644 ± 2363 vs. 2302 ± 1561 msec2), smaller absolute power of low frequency (LF) (386 ± 745 vs. 810 ± 1300 msec2) and high frequency (HF) (485 ± 1202 vs. 582 ± 555 msec2) of RR interval variability and smaller spontaneous baroreflex sensitivity (15.0 ± 8.9 vs. 21.9 ± 10 msec/mmHg), suggesting vagal impairment. VO2 peak and O2 pulse were lower in cancer survivors than in controls. Fatigue and stress-related somatic symptoms scores were higher, as was BMI and waist circumference.
Breast cancer survivors show multiple dysfunctions: vagal impairment, lower aerobic fitness, signs of altered metabolism, and higher perception of fatigue.
We propose that the concept of clinical phenotype, which may accommodate multiple functional disturbances, might be useful in long-term personalized prevention programs for breast cancer survivors.
手术及辅助治疗改善了乳腺癌幸存者的预后。这种改善可能会被肿瘤治疗潜在的迟发性心血管毒性以及与生活方式改变相关的心脏代谢风险增加所抵消。我们探讨了这样一个假设：在乳腺癌幸存者中，多种功能改变可能定义了一种表型，其特征为迷走神经功能受损、有氧适能下降、代谢风险增加以及幸福感降低。
我们研究了171名久坐不动且无症状的女性（106名癌症幸存者和65名对照者），她们年龄相仿（分别为53±8.6岁和51±8.1岁）。通过对R波到R波（RR）间期和收缩期动脉压变异性进行自回归谱分析来评估自主神经调节。通过心肺运动试验直接评估有氧适能。体重指数（BMI）和腰围作为代谢指标。使用经过验证的问卷评估疲劳和与压力相关的症状。
患者的RR间期总方差显著较小（1644±2363 vs. 2302±1561毫秒²），RR间期变异性的低频（LF）（386±745 vs. 810±1300毫秒²）和高频（HF）（485±1202 vs. 582±555毫秒²）绝对功率较小，并且自发性压力反射敏感性较小（15.0±8.9 vs. 21.9±10毫秒/毫米汞柱），提示迷走神经功能受损。癌症幸存者的峰值摄氧量和氧脉搏低于对照组。疲劳和与压力相关的躯体症状评分更高，BMI和腰围也是如此。
乳腺癌幸存者表现出多种功能障碍：迷走神经功能受损、有氧适能较低、代谢改变迹象以及更高的疲劳感。
我们提出，临床表型的概念可能适用于多种功能障碍，这可能对乳腺癌幸存者的长期个性化预防计划有用。
