Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Policy Analysis and Management, College of Human Ecology, Cornell University, Ithaca, NY, USA.
Breast. 2019 Feb;43:48-54. doi: 10.1016/j.breast.2018.11.003. Epub 2018 Nov 9.
Adjuvant radiation therapy (RT) for breast cancer is associated with heart disease, although the impact of patient-specific factors on the interaction between cardiac risk and RT is not well-studied in cancer patients. The objective of this study is to compare acute coronary events (ACE) among the general population and women with breast cancer after adjuvant RT. Secondary analysis evaluated whether a healthy lifestyle could protect against RT-related cardiac toxicity.
The National Health Insurance Service-Health Screening Cohort (2002-2013) was used to compare ACE risks among 1015 women with breast cancer and among 8120 women without cancer who were matched according to age, comorbidities, and smoking history. The risk of developing ACE over time while accounting for competing risks from other causes of death was analyzed.
During 6.1 ± 3.0 years of follow-up, the 5- and 10-year cumulative incidences of ACE were 5.5% and 11.3%, respectively. The breast cancer survivors who underwent breast radiotherapy and population-based matched sample had similar risks of ACE (hazard ratio: 0.94, 95% confidence interval: 0.69-1.28). However, in the sensitivity analysis, breast cancer survivors had increased risks of ACE if they did not exercise (hazard ratio 2.74, confidence interval: 1.27-5.91) or had a disability (hazard ratio 21.9, confidence interval: 2.50-191.6).
In this matched cohort study, the cardiac risk after adjuvant RT increased with decreasing physical activity. The long-term effect of physical activity on ACE is uncertain, but these results can increase physicians' awareness of the approaches to increase exercise participation level among women undergoing RT for breast cancer. Confirmatory studies with individual doses of cardiac radiation and quantification of physical activity and sedentary time are required for validating our results.
乳腺癌辅助放疗（RT）与心脏病有关，尽管患者特定因素对心脏风险与 RT 之间相互作用的影响在癌症患者中尚未得到充分研究。本研究的目的是比较接受辅助 RT 后的普通人群和乳腺癌女性之间的急性冠脉事件（ACE）。二次分析评估了健康的生活方式是否可以预防 RT 相关的心脏毒性。
利用国家健康保险服务-健康筛查队列（2002-2013 年），比较了 1015 名乳腺癌女性和 8120 名无癌症女性的 ACE 风险，这些女性按年龄、合并症和吸烟史进行了匹配。同时分析了在考虑其他死亡原因竞争风险的情况下，随着时间推移发展 ACE 的风险。
在 6.1±3.0 年的随访期间，5 年和 10 年 ACE 的累积发生率分别为 5.5%和 11.3%。接受乳腺癌放疗和基于人群匹配样本的乳腺癌幸存者 ACE 风险相似（风险比：0.94，95%置信区间：0.69-1.28）。然而，在敏感性分析中，如果乳腺癌幸存者不运动（风险比 2.74，95%置信区间：1.27-5.91）或残疾（风险比 21.9，95%置信区间：2.50-191.6），则 ACE 风险增加。
在这项匹配队列研究中，辅助 RT 后心脏风险随身体活动减少而增加。身体活动对 ACE 的长期影响尚不确定，但这些结果可以提高医生对提高接受乳腺癌 RT 治疗女性运动参与水平的方法的认识。需要进行个体化心脏辐射剂量的验证性研究，并量化身体活动和久坐时间，以验证我们的结果。
