Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Breast. 2020 Oct;53:125-129. doi: 10.1016/j.breast.2020.07.006. Epub 2020 Jul 31.
Although chemotherapy-induced congestive heart failure (CHF) is a well-known adverse event in cancer survivors, the long-term risk of standard low-dose anthracycline has not yet been reported. This study aimed to investigate the long-term effects of standard anthracycline on late CHF in breast cancer survivors.
A nationwide retrospective cohort study was conducted using the national insurance claims data for nearly 98% of Korean citizens. Between Jan 2010 and Dec 2015, a total of 56,338 newly diagnosed female breast cancer survivors were included.
The total number of person-years was 199,648 and the incidence rate of late CHF was 3.57 per 1000 person-years. In multivariate analysis according to the subject's age at diagnosis, only in the 50-59 age group, anthracycline-based [hazard ratio (HR) 1.765, 95% confidence interval (CI) 1.206-2.583] and taxane plus anthracycline-based regimens (HR 1.816, 95% CI 1.192-2.768) significantly increased the risk of late CHF. In the 50-59 age group, standard low-dose anthracycline significantly increased the risk of late CHF (HR 1.627, 95% CI 1.080-2.451) in Cox proportional hazard regression models. In competing risk model with recurrence and in-hospital death as competing risks, standard low-dose anthracycline was a significant risk factor for late CHF [subdistribution hazard ratio (SHR) 1.553, 95% CI 1.029-2.340].
This nationwide study showed that standard chemotherapy with low-dose anthracycline is a risk factor for late-onset CHF in breast cancer survivors who were in their 50 s at breast cancer diagnosis. Long-term monitoring of late CHF should be considered in these younger breast cancer survivors.
尽管化疗引起的充血性心力衰竭（CHF）是癌症幸存者中众所周知的不良反应，但标准低剂量蒽环类药物的长期风险尚未得到报道。本研究旨在探讨标准蒽环类药物对乳腺癌幸存者迟发性 CHF 的长期影响。
本研究使用全国医疗保险索赔数据进行了一项全国性回顾性队列研究，该数据涵盖了近 98%的韩国公民。2010 年 1 月至 2015 年 12 月期间，共纳入 56338 例新诊断的女性乳腺癌幸存者。
总随访人数为 199648 人年，迟发性 CHF 的发生率为 3.57/1000 人年。根据患者诊断时的年龄进行多变量分析，仅在 50-59 岁年龄组中，蒽环类药物[风险比（HR）1.765，95%置信区间（CI）1.206-2.583]和紫杉烷联合蒽环类药物方案（HR 1.816，95%CI 1.192-2.768）显著增加了迟发性 CHF 的风险。在 50-59 岁年龄组中，标准低剂量蒽环类药物在 Cox 比例风险回归模型中显著增加了迟发性 CHF 的风险（HR 1.627，95%CI 1.080-2.451）。在以复发和院内死亡为竞争风险的竞争风险模型中，标准低剂量蒽环类药物是迟发性 CHF 的显著危险因素[亚分布风险比（SHR）1.553，95%CI 1.029-2.340]。
本项全国性研究表明，标准低剂量蒽环类药物化疗是乳腺癌幸存者在乳腺癌诊断时年龄在 50 多岁时发生迟发性 CHF 的危险因素。应考虑对这些年轻的乳腺癌幸存者进行迟发性 CHF 的长期监测。
