Department of Cardiology, The Fifth People's Hospital of Shangrao City, Jiangxi Province, Shangrao 334099, China.
Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang 330006, China.
Comput Math Methods Med. 2022 Aug 8;2022:7963146. doi: 10.1155/2022/7963146. eCollection 2022.
The cardiac safety of concurrent treatment with anthracycline (A), cyclophosphamide (C), and paclitaxel (T) in an adjuvant BC treatment regimen is still under debate. In this study, we aimed to determine cardiotoxicity events following ACT chemotherapy among operable breast cancer patients without HER2-positive.
We searched PubMed and the Cochrane Library for RCTs prior to July 2019 evaluating the cardiac impairment of ACT chemotherapy regimens in BC patients. The search terms were "BC," "chemotherapy," "docetaxel or "doxorubicin," "paclitaxel," and "cyclophosphamide." Cardiotoxic events included LVEF decline ≥ 10 points, congestive heart failure (CHF), and cardiac death.
In total, 12 studies with 4032 subjects were included in this meta-analysis, and all patients received ACT regimen. The analysis results indicated that LVEF decrease ≥ 10 points was the most common cardiotoxic event (16%; (95% CI (8%-24%)) with = 95.75, < 0.001, = 95.8%). CHF showed the lowest rate (1%; (95% CI (0%-1%)) with = 8.00, = 0.433, = 0.0%). Subgroup analysis demonstrated that the incidence of CHF due to A → C → T chemotherapy regimen was lower than that of other events, however, without significance. No significant difference was observed in the occurrence of cardiac death.
The ACT regimen in patients with HER2-negative BC was associated with an increased risk of adverse cardiactoxic events.
蒽环类药物（A）、环磷酰胺（C）和紫杉醇（T）联合治疗辅助 BC 治疗方案的心脏安全性仍存在争议。本研究旨在确定无 HER2 阳性的可手术 BC 患者接受 ACT 化疗后的心脏毒性事件。
我们检索了 PubMed 和 Cochrane Library 数据库，以评估 BC 患者中 ACT 化疗方案的心脏损害的 RCTs，检索时间截至 2019 年 7 月。检索词为“BC”、“化疗”、“多西紫杉醇或多柔比星”、“紫杉醇”和“环磷酰胺”。心脏毒性事件包括 LVEF 下降≥10 个点、充血性心力衰竭（CHF）和心脏死亡。
共有 12 项研究，纳入 4032 例患者，所有患者均接受 ACT 方案治疗。分析结果表明，LVEF 下降≥10 个点是最常见的心脏毒性事件（16%；95%CI（8%-24%）， = 95.75， < 0.001， = 95.8%）。CHF 的发生率最低（1%；95%CI（0%-1%）， = 8.00， = 0.433， = 0.0%）。亚组分析表明，A→C→T 化疗方案引起的 CHF 发生率低于其他事件，但无统计学意义。未观察到心脏死亡的发生有显著差异。
HER2 阴性 BC 患者的 ACT 方案与不良心脏毒性事件风险增加相关。
