Agha Aya, Wang Xi, Wang Ming, Lehrer Eric J, Horn Samantha R, Rosenberg Jennifer C, Trifiletti Daniel M, Diaz Roberto, Louie Alexander V, Zaorsky Nicholas G
Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, United States.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.
Front Cardiovasc Med. 2022 Apr 13;9:784409. doi: 10.3389/fcvm.2022.784409. eCollection 2022.
Most breast cancer patients die of non-cancer causes. The risk of death from heart disease, a leading cause of death, is unknown. The aim of this study is to characterize the long-term risk of fatal heart disease in breast cancer patients.
This retrospective study used the Surveillance, Epidemiology, and End Results (SEER) database. Standard mortality ratios (SMR) were calculated for breast cancer patients diagnosed from 1992 to 2014. Patients were stratified by receipt of radiotherapy and/or chemotherapy, disease laterality, and diagnosis era. Hazard ratios (HRs) and odds ratios (ORs) were calculated to compare the risk of death from heart disease among other breast cancer patients.
There were 1,059,048 patients diagnosed with breast cancer from 1992 to 2014, of which 47,872 (4.6%) died from heart disease. The SMR for death from heart disease at 10+ years for patients who received only radiotherapy was 2.92 (95% CI 2.81-3.04, < 0.001) and in patients who received only chemotherapy was 5.05 (95% CI 4.57-5.55, < 0.001). There was no statistically significant difference in SMR for death from heart disease for left-sided vs. right-sided disease. At 10+ years, heart disease made up 28% of deaths from non-primary cancer. HRs and ORs showed that the risk of death from heart disease was highest in patients older than 70 years of age and with longer follow-up.
The risk of fatal heart disease was highest in older breast cancer patients with longer follow-up (i.e., >5-10 years) and who received chemotherapy. These patients should be referred to cardio-oncology clinics to mitigate this risk.
大多数乳腺癌患者死于非癌症原因。作为主要死因之一的心脏病导致的死亡风险尚不清楚。本研究的目的是描述乳腺癌患者致命性心脏病的长期风险。
这项回顾性研究使用了监测、流行病学和最终结果（SEER）数据库。计算了1992年至2014年诊断出的乳腺癌患者的标准化死亡比率（SMR）。患者按是否接受放疗和/或化疗、疾病侧别和诊断时代进行分层。计算风险比（HR）和优势比（OR），以比较其他乳腺癌患者中心脏病死亡风险。
1992年至2014年期间有1,059,048例乳腺癌患者被诊断，其中47,872例（4.6%）死于心脏病。仅接受放疗的患者10年以上心脏病死亡的SMR为2.92（95%CI 2.81 - 3.04，<0.001），仅接受化疗的患者为5.05（95%CI 4.57 - 5.55，<0.001）。左侧与右侧疾病的心脏病死亡SMR无统计学显著差异。在10年以上，心脏病占非原发性癌症死亡的28%。HR和OR表明，70岁以上且随访时间较长的患者心脏病死亡风险最高。
随访时间较长（即>5 - 10年）且接受化疗的老年乳腺癌患者致命性心脏病风险最高。这些患者应转诊至心脏肿瘤诊所以降低这种风险。
