Shinano Hiromi, Miyazaki Sakiko, Miura Kayo, Ohtsu Hiroshi, Yonemoto Naohiro, Matsuoka Kiyoshi, Konishi Hakuou, Daida Hiroyuki, Saito Mitsue, Sase Kazuhiro
Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University Tokyo Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, Juntendo University Tokyo Japan.
Circ Rep. 2020 Mar 24;2(4):235-242. doi: 10.1253/circrep.CR-19-0119.
The prognosis of cancer survivors has dramatically improved, but effective strategies for cancer treatment-related cardiovascular disorders (CTRCD) remain to be elucidated in the emerging field of cardio-oncology. In this study, we investigated risk factors for CTRCD in breast cancer patients treated with trastuzumab. We performed a retrospective analysis of 141 consecutive women who received adjuvant trastuzumab, and underwent baseline (BL) and follow-up (FU) echocardiography at Juntendo University between April 2010 and December 2016. The major concomitant treatment was anthracyclines in 94% and radiotherapy in 53%. During the median treatment period of 11 months, there were 22 (15.6%) cardiology consultations, 3 (2.1%) treatment interruptions with irreversible CTRCD, and no deaths. Left ventricular ejection fraction (LVEF) was decreased from a median 67.5% (BL) to 63.4% (FU; P<0.0001), with reduced LVEF noted in 26.2% at FU<90%BL, in 13.5% at FU<BL-10%, and in 5.7% at LVEF <53%. A significantly greater percentage of patients with CTRCD (FU<BL-10% and LVEF <53%) had cardiovascular risk factors (CVRF; 42.9% vs. 8.2%, P=0.02). On multivariable analysis, CVRF were also significantly associated with CTRCD (OR, 11.96; 95% CI: 1.30-110.34). Adjuvant trastuzumab for early-stage breast cancer was associated with reduced LVEF; and CVRF were an independent predictor for CTRCD. The concomitant effect of anthracyclines should not be underestimated, even at lower doses.
癌症幸存者的预后有了显著改善，但在新兴的心衰肿瘤学领域，癌症治疗相关心血管疾病（CTRCD）的有效治疗策略仍有待阐明。在本研究中，我们调查了接受曲妥珠单抗治疗的乳腺癌患者发生CTRCD的危险因素。我们对141例连续接受辅助曲妥珠单抗治疗的女性进行了回顾性分析，这些患者于2010年4月至2016年12月在顺天堂大学接受了基线（BL）和随访（FU）超声心动图检查。主要的联合治疗是94%的患者使用蒽环类药物，53%的患者接受放疗。在中位治疗期11个月内，有22例（15.6%）进行了心脏科会诊，3例（2.1%）因不可逆的CTRCD中断治疗，无死亡病例。左心室射血分数（LVEF）从中位值67.5%（BL）降至63.4%（FU；P<0.0001），随访时LVEF<90%BL的患者占26.2%，LVEF<BL-10%的患者占13.5%，LVEF<53%的患者占5.7%。发生CTRCD的患者（LVEF<BL-10%和LVEF<53%）中，有心血管危险因素（CVRF）的患者比例显著更高（42.9%对8.2%，P=0.02）。多变量分析显示，CVRF也与CTRCD显著相关（OR，11.96；95%CI：1.30-110.34）。早期乳腺癌辅助曲妥珠单抗治疗与LVEF降低有关；CVRF是CTRCD的独立预测因素。即使是较低剂量，蒽环类药物的联合作用也不应被低估。
