Women's College Hospital (WCH), Toronto, Ontario, Canada.
Ted Rogers Program in Cardiotoxicity Prevention, Division of Cardiology, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada.
Can J Cardiol. 2020 Oct;36(10):1658-1666. doi: 10.1016/j.cjca.2019.12.021. Epub 2019 Dec 28.
There are limited data on the yield of routine cardiac imaging for trastuzumab-treated patients with breast cancer.
We conducted a retrospective cohort study of patients with breast cancer treated with adjuvant trastuzumab between 2007 and 2012 at Princess Margaret Cancer Centre (Toronto, Canada). We classified imaging tests as clinically prompted or routinely ordered and determined whether each test led to changes in patient care. A generalized estimating equation model was used to determine if patient characteristics predicted routine studies more likely to change care. We analysed routine tests that were exclusively preceded by consecutive tests that did not change care to determine if their yield differed by time since trastuzumab start and the number of prior tests that did not change care.
We identified 448 patients who received 1735 cardiac imaging studies after trastuzumab initiation. Of 1555 routine tests, 44 led to changes in care (2.8%) for 43 patients, whereas 50 of 180 clinically prompted tests (27.8%) altered care in 29 patients (P-value < 0.001). Earlier stage cancer, diabetes, prior anthracyclines, and prior cardiovascular disease were associated with a higher likelihood of changes in care following routine tests (P-value < 0.05). Among routine tests that were exclusively preceded by consecutive tests that did not change care, tests ordered outside months 3-9 and those that followed ≥ 3 tests were even less likely to change care.
Routine cardiac imaging tests rarely changed care for trastuzumab-treated patients with breast cancer, particularly among lower risk anthracycline-naïve women who had multiple prior tests that did not change care.
曲妥珠单抗治疗乳腺癌患者常规心脏影像学检查的结果有限。
我们对 2007 年至 2012 年在加拿大多伦多玛格丽特公主癌症中心接受曲妥珠单抗辅助治疗的乳腺癌患者进行了回顾性队列研究。我们将影像学检查分为临床提示性检查和常规性检查，并确定每项检查是否改变了患者的治疗方案。使用广义估计方程模型来确定患者特征是否可以预测更有可能改变治疗方案的常规性检查。我们分析了仅由未改变治疗方案的连续检查所预先安排的常规检查，以确定其结果是否因曲妥珠单抗起始后时间和未改变治疗方案的检查次数而异。
我们确定了 448 例在曲妥珠单抗治疗后接受了 1735 次心脏影像学检查的患者。在 1555 次常规检查中，有 44 次（2.8%）导致 43 名患者的治疗方案发生改变，而 180 次临床提示性检查中有 50 次（27.8%）改变了 29 名患者的治疗方案（P 值<0.001）。癌症分期较早、患有糖尿病、既往接受过蒽环类药物治疗和既往患有心血管疾病与常规检查后改变治疗方案的可能性更高相关（P 值<0.05）。在仅由未改变治疗方案的连续检查所预先安排的常规检查中，在 3-9 个月外进行的检查和检查次数≥3 次的检查改变治疗方案的可能性更小。
常规心脏影像学检查很少改变曲妥珠单抗治疗乳腺癌患者的治疗方案，特别是对于低风险的蒽环类药物初治女性，她们之前有多次未改变治疗方案的检查。
