Lu Qi, Wu Xian, Zhu Yanhui, Yang Junzhe, Wang Xingmeng, Ye Chaoran, Cai Ruyu, Zhang Kai, Xu Tingyu, Wang Bing, Veeramootoo Jordee S, Xia Tiansong, Liu Xiaoan
Department of Thyroid and Breast Surgery, The Second People's Hospital of Kunshan, Kunshan Jiangsu 215300, People's Republic of China.
Department of Breast Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, People's Republic of China.
Cancer Manag Res. 2020 Sep 11;12:8397-8408. doi: 10.2147/CMAR.S253397. eCollection 2020.
Chemotherapy is a comprehensive therapy for breast cancer; nevertheless, its associated adverse effects are drawing increasing attention with the continuous improvement of the efficacy. The changes in serum lipids of breast cancer patients caused by chemotherapy have been reported by previous studies, whereby the former increase the incidence rate of cardiovascular disorders. However, the variations in the changes of serum lipids with different chemotherapy regimens have seldom been reported.
From January 2011 to December 2017, 1740 breast cancer patients treated with chemotherapy were recruited at the First Affiliated Hospital of Nanjing Medical University. The chemotherapy regimens included anthracycline-based, taxane-based, and anthracycline-plus-taxane-based regimens, dose-dense and standard-interval regimens. Lipid profiles that contained TG (triglyceride), TC (total cholesterol), HDL-C (high-density lipoprotein cholesterol), LDL-C (low-density lipoprotein cholesterol) and Lpa (lipoprotein a) levels were collected prior to the first, second and last cycles of chemotherapy. The changes of serum lipids with the same or different chemotherapy regimens were analyzed and compared.
It was observed that the levels of TG, TC, LDL-C and Lpa increased significantly while that of HDL-C decreased after adjuvant chemotherapy in breast cancer patients (P<0.05). Besides, dose-dense regimens had more influence in TG and HDL-C and less influence in TC and LDL-C than standard-interval regimens. HDL-C was more sensitive to anthracycline-based regimens than taxane-based regimens. The level of TG with anthracycline-plus-taxane-based regimens was higher than that with only anthracycline-based or taxane-based regimens, and the level of HDL-C with anthracycline-plus-taxane-based regimen showed lower than that with taxane-based regimen.
In summary, this study proposed that dyslipidemia was strongly associated with chemotherapy in Chinese breast cancer patients after operative treatment. Furthermore, the changes in levels of serum lipids varied among patients with different chemotherapy regimens and taxane had less effect on dyslipidemia than anthracycline.
化疗是乳腺癌的综合治疗方法;然而,随着疗效的不断提高,其相关不良反应日益受到关注。既往研究报道了化疗导致乳腺癌患者血清脂质的变化,进而增加了心血管疾病的发病率。然而,不同化疗方案引起的血清脂质变化鲜有报道。
2011年1月至2017年12月,南京医科大学第一附属医院招募了1740例接受化疗的乳腺癌患者。化疗方案包括蒽环类、紫杉类以及蒽环类加紫杉类方案,剂量密集和标准间隔方案。在化疗的第1、2和最后一个周期之前收集包含甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和脂蛋白a(Lpa)水平的血脂谱。分析并比较相同或不同化疗方案下血清脂质的变化。
观察发现,乳腺癌患者辅助化疗后TG、TC、LDL-C和Lpa水平显著升高,而HDL-C水平降低(P<0.05)。此外,与标准间隔方案相比,剂量密集方案对TG和HDL-C的影响更大,对TC和LDL-C的影响更小。HDL-C对蒽环类方案比紫杉类方案更敏感。蒽环类加紫杉类方案的TG水平高于仅使用蒽环类或紫杉类方案,蒽环类加紫杉类方案的HDL-C水平低于紫杉类方案。
总之,本研究表明中国乳腺癌患者术后血脂异常与化疗密切相关。此外,不同化疗方案患者的血清脂质水平变化各异,紫杉类对血脂异常的影响小于蒽环类。