Sardar Partha, Kundu Amartya, Chatterjee Saurav, Nohria Anju, Nairooz Ramez, Bangalore Sripal, Mukherjee Debabrata, Aronow Wilbert S, Lavie Carl J
Division of Cardiovascular Medicine, University of Utah, Salt Lake City.
Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
Clin Cardiol. 2017 Feb;40(2):73-81. doi: 10.1002/clc.22631. Epub 2016 Nov 2.
Radiotherapy (RT) is frequently associated with late cardiovascular (CV) complications. The mean cardiac dose from irradiation of a left-sided breast cancer is much higher than that for a right-sided breast cancer. However, data is limited on the long-term risks of RT on CV mortality.
RT for breast cancer is associated with long term CV mortality and left sided RT carries a greater mortality than right sided RT.
We searched PubMed, Cochrane Central, Embase, EBSCO, Web of Science, and CINAHL databases from inception through December 2015. Studies reporting CV mortality with RT for left- vs right-sided breast cancers were included. The principal outcome of interest was CV mortality. We calculated summary risk ratio (RR) and 95% confidence intervals (CI) with the random-effects model.
The analysis included 289 109 patients from 13 observational studies. Women who had received RT for left-sided breast cancer had a higher risk of CV death than those who received RT for a right-sided breast cancer (RR: 1.12, 95% CI: 1.07-1.18, P < 0.001; number needed to harm: 353). Difference in CV mortality between left- vs right-sided breast RT was more apparent after 15 years of follow-up (RR: 1.23, 95% CI: 1.08-1.41, P < 0.001; number needed to harm: 95).
CV mortality from left-sided RT was significantly higher compared with right-sided RT for breast cancer and was more apparent after ≥15 years of follow-up.
放射治疗（RT）常与晚期心血管（CV）并发症相关。左侧乳腺癌放疗的平均心脏剂量远高于右侧乳腺癌。然而，关于放疗对心血管死亡率的长期风险的数据有限。
乳腺癌放疗与长期心血管死亡率相关，左侧放疗的死亡率高于右侧放疗。
我们检索了从数据库建立至2015年12月的PubMed、Cochrane Central、Embase、EBSCO、Web of Science和CINAHL数据库。纳入报告左侧与右侧乳腺癌放疗后心血管死亡率的研究。主要关注的结果是心血管死亡率。我们采用随机效应模型计算汇总风险比（RR）和95%置信区间（CI）。
分析纳入了来自13项观察性研究的289109例患者。接受左侧乳腺癌放疗的女性心血管死亡风险高于接受右侧乳腺癌放疗的女性（RR：1.12，95%CI：1.07 - 1.18，P < 0.001；伤害所需人数：353）。左侧与右侧乳腺癌放疗后心血管死亡率的差异在随访15年后更为明显（RR：1.23，95%CI：1.08 - 1.41，P < 0.001；伤害所需人数：95）。
乳腺癌左侧放疗的心血管死亡率显著高于右侧放疗，且在随访≥15年后更为明显。
