Rushton M, Johnson C, Dent S
The Ottawa Hospital Cancer Centre, and.
Department of Medicine, Division of Cardiology, The Ottawa Hospital, Ottawa, ON.
Curr Oncol. 2017 Jun;24(3):176-180. doi: 10.3747/co.24.3349. Epub 2017 Jun 27.
Trastuzumab has improved survival for women with her2-positive breast cancer, but its use is associated with an increased risk of cardiotoxicity. With increased survivorship, the long-term effects of cancer treatment are an important consideration for clinicians and patients. We reviewed the current literature on predicting trastuzumab-related cardiotoxicity and tested a clinical risk score (crs) in a real-world breast cancer population to assess its utility in predicting permanent cardiotoxicity.
In this retrospective exploratory cohort study of breast cancer patients referred to a cardio-oncology clinic at a tertiary care centre between October 2008 and August 2014, a crs was calculated for each patient, and a sensitivity analysis was performed.
Of the 143 patients included in the study, 62 (43%) experienced a cardiac event, and of those 62 patients, 43 (69%) experienced full recovery of cardiac function. In applying the crs, 119 patients (83%) would be considered at low risk, 14 (10%) at moderate risk, and 10 (7%) at high risk to develop heart failure or cardiomyopathy. When applied to the study population, the high-risk cut-off score had a sensitivity of 0.13 [95% confidence interval (ci): 0.08 to 0.20] and a specificity of 0.94 (95% ci: 0.87 to 0.97). The positive predictive value was 0.07 (95% ci: 0.03 to 0.13), and the negative predictive value was 0.93 (95% ci: 0.87 to 0.96).
The crs demonstrated good specificity and negative predictive value for the development of permanent cardiotoxicity in a real-world population of breast cancer patients, suggesting that intensive cardiac monitoring might not be warranted in low-risk patients, but that high-risk patients might benefit from early referral to cardio-oncology for optimization. Further study using the crs in a larger breast cancer population is warranted to identify patients at low risk of long-term trastuzumab-related cardiotoxicity.
曲妥珠单抗改善了HER2阳性乳腺癌女性的生存率，但其使用与心脏毒性风险增加相关。随着生存期的延长，癌症治疗的长期影响是临床医生和患者的重要考虑因素。我们回顾了当前关于预测曲妥珠单抗相关心脏毒性的文献，并在一个真实世界的乳腺癌人群中测试了一种临床风险评分（CRS），以评估其在预测永久性心脏毒性方面的效用。
在这项对2008年10月至2014年8月期间转诊至一家三级医疗中心心脏肿瘤门诊的乳腺癌患者进行的回顾性探索性队列研究中，为每位患者计算了CRS，并进行了敏感性分析。
在纳入研究的143例患者中，62例（43%）发生了心脏事件，在这62例患者中，43例（69%）心脏功能完全恢复。应用CRS时，119例患者（83%）被认为发生心力衰竭或心肌病的风险较低，14例（10%）为中度风险，10例（7%）为高风险。当应用于研究人群时，高风险临界值评分的敏感性为0.13[95%置信区间（CI）：0.08至0.20]，特异性为0.94（95%CI：0.87至0.97）。阳性预测值为0.07（95%CI：0.03至0.13），阴性预测值为0.93（95%CI：0.87至0.96）。
CRS在真实世界的乳腺癌患者人群中对永久性心脏毒性的发生显示出良好的特异性和阴性预测值，这表明低风险患者可能不需要进行强化心脏监测，但高风险患者可能受益于早期转诊至心脏肿瘤门诊进行优化治疗。有必要在更大的乳腺癌人群中进一步研究使用CRS，以识别长期曲妥珠单抗相关心脏毒性低风险的患者。
