Nardone Valerio, Reginelli Alfonso, De Marco Giuseppina, Natale Giovanni, Patanè Vittorio, De Chiara Marco, Buono Mauro, Russo Gaetano Maria, Monti Riccardo, Balestrucci Giovanni, Salvarezza Maria, Di Guida Gaetano, D'Ippolito Emma, Sangiovanni Angelo, Grassi Roberta, D'Onofrio Ida, Belfiore Maria Paola, Cimmino Giovanni, Della Corte Carminia Maria, Vicidomini Giovanni, Fiorelli Alfonso, Gambardella Antonio, Morgillo Floriana, Cappabianca Salvatore
Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy.
Department of Translational Medical Science, University of Campania "L. Vanvitelli", 80138 Naples, Italy.
Diagnostics (Basel). 2023 Jan 22;13(3):400. doi: 10.3390/diagnostics13030400.
Treatment-induced cardiac toxicity represents an important issue in non-small cell lung cancer (NSCLC) patients, and no biomarkers are currently available in clinical practice. A novel and easy-to-calculate marker is the quantitative analysis of calcium plaque in the coronary, calculated on CT. It is called the Agatston score (or CAD score). At the same time, other potential predictors include cardiac ultrasonography and anamnesis of the patients. Our work aimed to correlate cardiac biomarkers with overall survival (OS) in NSCLC patients. We retrospectively analyzed patients with NSCLC discussed in the Multidisciplinary Tumor Board of our Institute for the present analysis between January 2018 and July 2022. Inclusion criteria were the availability of basal CT imaging of the thorax, cardiac ultrasonography with the calculation of ejection fraction (EF), and complete anamnesis, including assessment of co-pathologies and pharmacological drugs. The clinical data of the patients were retrospectively collected, and the CAD scores was calculated on a CT scan. All of these parameters were correlated with overall survival (OS) with univariate analysis (Kaplan-Meier analysis) and multivariate analysis (Cox regression analysis). Following the above-mentioned inclusion criteria, 173 patients were included in the present analysis. Of those, 120 patients died in the follow-up period (69.6%), and the median overall survival (OS) was 28 months (mean 47.2 months, 95% CI, 36-57 months). In univariate analysis, several parameters that significantly correlated with lower OS were the stage ( < 0.001), the CAD grading ( < 0.001), history of ischemic heart disease (: 0.034), use of beta blocker drugs (: 0.036), and cardiac ejection fraction (: 0.005). In multivariate analysis, the only parameters that remained significant were as follows: CAD score (: 0.014, OR 1.56, 95% CI: 1.04-1.83), stage (: 0.016, OR: 1.26, 95% CI: 1.05-1.53), and cardiac ejection fraction (: 0.011, OR 0.46, 95% CI: 0.25-0.84). Both CAD score and ejection fraction are correlated with survival in NSCLC patients at all stages of the disease. Independently from the treatment choice, a cardiological evaluation is mandatory for patients with NSCLC.
治疗引起的心脏毒性是非小细胞肺癌（NSCLC）患者中的一个重要问题，目前临床实践中尚无生物标志物可用。一种新颖且易于计算的标志物是基于CT计算的冠状动脉钙化斑块定量分析。它被称为阿加斯顿评分（或CAD评分）。同时，其他潜在的预测指标包括心脏超声检查和患者的既往史。我们的研究旨在将心脏生物标志物与NSCLC患者的总生存期（OS）相关联。我们回顾性分析了2018年1月至2022年7月期间在我们研究所的多学科肿瘤委员会中讨论的NSCLC患者，用于本次分析。纳入标准包括胸部基础CT成像、计算射血分数（EF）的心脏超声检查以及完整的既往史，包括合并症和药物评估。回顾性收集患者的临床数据，并在CT扫描上计算CAD评分。所有这些参数通过单因素分析（Kaplan-Meier分析）和多因素分析（Cox回归分析）与总生存期（OS）相关联。按照上述纳入标准，本分析纳入了173例患者。其中，120例患者在随访期间死亡（69.6%），中位总生存期（OS）为28个月（平均47.2个月，95%CI，36 - 57个月）。在单因素分析中，与较低OS显著相关的几个参数是分期（<0.001）、CAD分级（<0.001）、缺血性心脏病史（:0.034）、β受体阻滞剂药物的使用（:0.036）以及心脏射血分数（:0.005）。在多因素分析中，仍然显著的唯一参数如下：CAD评分（:0.014，OR 1.56，95%CI：1.04 - 1.83）、分期（:0.016，OR：1.26，95%CI：1.05 - 1.53）以及心脏射血分数（:0.011，OR 0.46，95%CI：0.25 - 0.84）。CAD评分和射血分数均与NSCLC患者在疾病各个阶段的生存期相关。无论治疗选择如何，对于NSCLC患者，进行心脏评估是必不可少的。
