Department of Radiation Oncology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan.
Postgrad Med. 2022 May;134(4):413-419. doi: 10.1080/00325481.2021.1997509. Epub 2021 Nov 17.
Adjuvant radiotherapy (RT) in patients with breast cancer can adversely cause the heart to receive some radiation doses, which may lead to cardiovascular diseases. The results of previous research regarding this issue are not consistent. Therefore, we conducted a nationwide population-based study in Taiwan to evaluate whether adjuvant RT for breast cancer patients increased the risk of developing coronary heart disease (CHD).
This retrospective cohort study examined data from the National Health Insurance Research Database, Registry for Catastrophic Illness Patients, and Taiwan Cancer Registry Database. We identified 83,733 patients with breast cancer between 1 January 2000 and 31 December 2017. Individuals without breast cancer from the general population were frequency-matched by age and index year with individuals with breast cancer. Participants were followed until the occurrence of a CHD event, the end of follow-up, or patient record removal due to death or withdrawal from the NHI. A Cox proportional hazards regression analysis was conducted to compare the risk of CHD in breast cancer patients with that in patients in the comparison cohort.
Compared to breast cancer patients without RT, those who underwent RT had a similar risk of subsequently developing CHD (adjusted hazard ratio, 0.94; 95% confidence interval, 0.87-1.02). Similar results were observed in a subgroup of patients with left-sided breast cancer. However, among patients who received adjuvant RT, those with left-sided breast cancer had a significantly higher risk of CHD than did those with right-sided breast cancer (adjusted hazard ratio, 1.17; 95% confidence interval, 1.04-1.30). Patients who received RT in 2010 or later had a significantly lower risk of CHD compared with those who received RT before 2010 (adjusted hazard ratio, 0.64; 95% confidence interval, 0.45-0.91). Higher prescribed doses of RT to the left-sided breast did not correspond to a higher risk of CHD.
This large, nationwide cohort study suggests that adjuvant RT in patients with breast cancer did not increase the risk of CHD.
乳腺癌患者的辅助放疗（RT）可能会使心脏受到一定剂量的辐射，从而导致心血管疾病。先前关于这一问题的研究结果并不一致。因此，我们在台湾进行了一项全国性的基于人群的研究，以评估乳腺癌患者接受辅助 RT 是否会增加患冠心病（CHD）的风险。
本回顾性队列研究分析了国家健康保险研究数据库、灾难性疾病患者登记处和台湾癌症登记数据库的数据。我们确定了 2000 年 1 月 1 日至 2017 年 12 月 31 日期间 83733 例乳腺癌患者。从普通人群中按年龄和索引年份与乳腺癌患者进行频数匹配，选择无乳腺癌的个体。参与者随访至 CHD 事件发生、随访结束或因死亡或退出全民健康保险而从记录中删除。采用 Cox 比例风险回归分析比较了接受 RT 与未接受 RT 的乳腺癌患者的 CHD 风险。
与未接受 RT 的乳腺癌患者相比，接受 RT 的患者发生 CHD 的风险相似（调整后的危险比，0.94；95%置信区间，0.87-1.02）。在左侧乳腺癌患者亚组中也观察到了类似的结果。然而，在接受辅助 RT 的患者中，左侧乳腺癌患者患 CHD 的风险显著高于右侧乳腺癌患者（调整后的危险比，1.17；95%置信区间，1.04-1.30）。与 2010 年之前接受 RT 的患者相比，2010 年或之后接受 RT 的患者 CHD 的风险显著降低（调整后的危险比，0.64；95%置信区间，0.45-0.91）。左侧乳腺接受的 RT 处方剂量较高与 CHD 风险增加无关。
这项大型全国性队列研究表明，乳腺癌患者接受辅助 RT 不会增加 CHD 的风险。
