Law W, Johnson C, Rushton M, Dent S
Faculty of Medicine.
Division of Cardiology, Department of Medicine, and.
Curr Oncol. 2017 Oct;24(5):e348-e353. doi: 10.3747/co.24.3684. Epub 2017 Oct 25.
Patients with breast cancer (bca) who overexpress her2 (the human epidermal growth factor receptor 2) are at risk for cardiotoxicity when treated with anthracycline-based chemotherapy and her2-targeted agents. The Framingham risk score (frs) is a validated tool that stratifies patients into high-, intermediate-, or low-risk groups and calculates their 10-year risk of developing cardiovascular disease (cvd) based on past medical history, systolic blood pressure, and measurement of serum lipids. We retrospectively analyzed patients with her2-positive bca to determine whether the frs predicts adverse cardiovascular (CV) events or cardiotoxicity in patients treated using anthracyclines or her2-targeted therapy, or both.
The frs was determined for patients with bca referred to The Ottawa Hospital Cardiology-Oncology Clinic from October 2008 to August 2014. The patients were stratified into high (≥20%), intermediate (10%-20%), and low (<10%) 10-year cv risk groups. Primary outcomes included cvd-related hospitalizations and deaths, and cardiotoxicity [drop in left ventricular ejection fraction (lvef) of >10% to a lvef ≤50%].
Of the 152 patients included in the analysis (median follow-up: 40.7 months; range: 3.5-263 months), 47 (31%) were classified as high risk; 36 (24%), as intermediate risk; and 69 (45%), as low-risk. The number of cvd-related hospitalizations and deaths was 22, for an overall prevalence of 14%, with significantly more events occurring in high-risk than in low-risk patients (odds ratio: 4.18; 95% confidence limits: 1.47, 11.89). The frs predicted a 10-year risk of any cv event of 11.2% and underestimated the actual rate of cv events in the entire cohort. High frs was not associated with cardiotoxicity ( = 0.82).
In a population of patients with her2-positive bca referred to a cardiology-oncology clinic, the frs does not accurately predict the risk of cv events or cardiotoxicity.
人表皮生长因子受体2（HER2）过表达的乳腺癌患者在接受蒽环类化疗和HER2靶向药物治疗时存在心脏毒性风险。弗雷明汉风险评分（FRS）是一种经过验证的工具，可将患者分为高、中、低风险组，并根据既往病史、收缩压和血脂测量结果计算其患心血管疾病（CVD）的10年风险。我们回顾性分析了HER2阳性乳腺癌患者，以确定FRS是否能预测接受蒽环类药物或HER2靶向治疗或两者联合治疗的患者发生不良心血管（CV）事件或心脏毒性的情况。
确定2008年10月至2014年8月转诊至渥太华医院心脏肿瘤诊所的乳腺癌患者的FRS。患者被分为10年CV高风险（≥20%）、中风险（10%-20%）和低风险（<10%）组。主要结局包括与CVD相关的住院和死亡，以及心脏毒性[左心室射血分数（LVEF）下降>10%至LVEF≤50%]。
纳入分析的152例患者（中位随访时间：40.7个月；范围：3.5-263个月）中，47例（31%）被归类为高风险；36例（24%）为中风险；69例（45%）为低风险。与CVD相关的住院和死亡人数为22例，总体患病率为14%，高风险患者发生的事件明显多于低风险患者（比值比：4.18；95%置信区间：1.47，11.89）。FRS预测任何CV事件的10年风险为11.2%，并低估了整个队列中CV事件的实际发生率。高FRS与心脏毒性无关（P=0.82）。
在转诊至心脏肿瘤诊所的HER2阳性乳腺癌患者群体中，FRS不能准确预测CV事件或心脏毒性的风险。
