Suntheralingam Sivisan, Fan Chun-Po Steve, Calvillo-Argüelles Oscar, Abdel-Qadir Husam, Amir Eitan, Thavendiranathan Paaladinesh
Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2N2, Canada.
Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON M5G 2N2, Canada.
J Clin Med. 2022 Feb 5;11(3):847. doi: 10.3390/jcm11030847.
Cancer-therapeutics-related cardiac dysfunction (CTRCD) is an important concern in women receiving trastuzumab therapy for HER2+ breast cancer. However, the ability to assess CTRCD risk remains limited. In this retrospective cohort study, we apply three published risk prediction models (Ezaz et al., NSABP-31 cardiac risk scores (CRS), and HFA-ICOS trastuzumab proforma) to 629 women (mean age 52.4 ± 10.9 years) with Stage I-III HER2+ breast cancer treated with trastuzumab ± anthracyclines to assess their performance to identify CTRCD during or immediately post treatment. Using these models, patients were classified into CTRCD risk categories according to the pre-treatment characteristics. With NSABP-31 CRS and HFA-ICOS proformas, patients in the highest risk category had a 1.7-to-2.4-fold higher relative risk of CTRCD than the low-risk category ( = 0.010 and 0.005, respectively). However, with all three risk models, those in the low-risk category had a high absolute risk of CTRCD (15.5-25.5%). The discrimination of the models for CTRCD (AUC 0.51-0.60) and their calibration was limited. NSAP-31 CRS and HFA-ICOS proformas can identify relative differences in CTRCD risk between patients, but when considering absolute risk, they are only able to identify the highest risk patients. There remains an ongoing need for accurate CTRCD risk prediction models in women with HER2+ breast cancer.
癌症治疗相关的心脏功能障碍（CTRCD）是接受曲妥珠单抗治疗的HER2+乳腺癌女性患者的一个重要问题。然而，评估CTRCD风险的能力仍然有限。在这项回顾性队列研究中，我们将三种已发表的风险预测模型（Ezaz等人的模型、NSABP-31心脏风险评分（CRS）和HFA-ICOS曲妥珠单抗预填表）应用于629名年龄在52.4±10.9岁之间、接受曲妥珠单抗±蒽环类药物治疗的I-III期HER2+乳腺癌女性患者，以评估这些模型在识别治疗期间或治疗后立即发生的CTRCD方面的表现。使用这些模型，根据治疗前特征将患者分为CTRCD风险类别。使用NSABP-31 CRS和HFA-ICOS预填表时，最高风险类别的患者发生CTRCD的相对风险比低风险类别高1.7至2.4倍（分别为 = 0.010和0.005）。然而，使用所有三种风险模型时，低风险类别的患者发生CTRCD的绝对风险都很高（15.5-25.5%）。这些模型对CTRCD的辨别能力（AUC为0.51-0.60）及其校准能力有限。NSAP-31 CRS和HFA-ICOS预填表可以识别患者之间CTRCD风险的相对差异，但考虑绝对风险时，它们只能识别最高风险的患者。对于HER2+乳腺癌女性患者，仍然迫切需要准确的CTRCD风险预测模型。
