1st Department of Cardiology, State Hospital for Cardiology, Balatonfüred, Hungary.
Healthcare Business Analytics Research and Development Centre, University of Pannonia, Veszprém, Hungary.
Int J Cardiol. 2019 Jun 15;285:47-52. doi: 10.1016/j.ijcard.2019.03.013. Epub 2019 Mar 15.
Dilated cardiomyopathy (DCM) incidence during and after anthracycline therapy is highly dependent on anthracycline cumulative dose (CD), but its detailed risk factors remained unexplored. Our aim was to assess heart failure (HF) incidence after epirubicin therapy and construct a HF risk-prediction score.
A retrospective study was conducted by anonymized integration of nationwide healthcare databases. All the analysed patients were diagnosed with breast carcinoma confirmed by histology from 2007 to 2016. Participants did not undergo chemo- or radiotherapy or suffer HF/DCM during the preceding 3 years. The HF endpoint was established by assignment of I50 International Classification of Diseases (ICD) codes upon discharge from hospital or issuance of an autopsy report. 8068 patients treated with epirubicin were analysed. The 3-10-year HF cumulative incidence was 6.9%. Using binomial logistic regression the independent predictors were identified. A CD-dependent and significant effect on HF was revealed for epirubicin (threshold dose: 709 mg/m, odds ratio (OR): 1.76) and docetaxel (CD: >510 mg/m, OR: 1.59; CD ≤510 mg/m, OR: 1.28, respectively). HF risk increased with age, even over 40. A risk-prediction score derived from regression coefficients consisting of age, diabetes mellitus, hypertension, coronary artery disease, stroke, epirubicin CD, docetaxel CD, capecitabine, gemcitabine, bevacizumab and cancer stage was able to classify HF risk over a wide range (2-30%).
Long-term HF risk for patients treated with epirubicin was stratified by our risk-prediction score with a nearly 15-fold difference between the lowest and highest groups.
蒽环类药物治疗期间和之后扩张型心肌病（DCM）的发生率高度依赖于蒽环类药物累积剂量（CD），但其详细的危险因素仍未得到探索。我们的目的是评估表柔比星治疗后的心力衰竭（HF）发生率，并构建 HF 风险预测评分。
通过匿名整合全国医疗保健数据库进行回顾性研究。所有分析的患者均于 2007 年至 2016 年通过组织学诊断为乳腺癌。参与者在之前的 3 年内未接受化疗或放疗，也未患有 HF/DCM。HF 终点通过医院出院时分配 I50 国际疾病分类（ICD）代码或发布尸检报告来确定。共分析了 8068 例接受表柔比星治疗的患者。3-10 年 HF 累积发生率为 6.9%。使用二项逻辑回归确定了独立预测因子。发现表柔比星（阈值剂量：709mg/m，优势比（OR）：1.76）和多西他赛（CD：>510mg/m，OR：1.59；CD≤510mg/m，OR：1.28）与 HF 呈 CD 依赖性和显著相关。HF 风险随着年龄的增长而增加，甚至超过 40 岁。由年龄、糖尿病、高血压、冠状动脉疾病、中风、表柔比星 CD、多西他赛 CD、卡培他滨、吉西他滨、贝伐珠单抗和癌症分期的回归系数得出的风险预测评分能够在较宽范围内（2-30%）对 HF 风险进行分类。
接受表柔比星治疗的患者的长期 HF 风险由我们的风险预测评分分层，最低组和最高组之间的差异近 15 倍。
