运动训练对接受蒽环类化疗的乳腺癌女性心脏毒性标志物的影响：一项随机对照试验。

Effects of exercise training on cardiac toxicity markers in women with breast cancer undergoing chemotherapy with anthracyclines: a randomized controlled trial.

机构信息

Research Center in Sport Sciences, Health and Human Development (CIDESD), Sport Sciences Department, University of Beira Interior, Convento de Santo António, 6201-001 Covilhã, Portugal.

ONCOMOVE, AICSO - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Avenida João Paulo II, nº 911, loja 9, 4410-406 Vila Nova de Gaia, Portugal.

出版信息

Eur J Prev Cardiol. 2023 Jul 12;30(9):844-855. doi: 10.1093/eurjpc/zwad063.

DOI:10.1093/eurjpc/zwad063

PMID:36857149

Abstract

AIMS

Exercise training has been suggested to prevent anthracycline-related cardiac dysfunction, but clinicalbased evidence is scarce. We investigated the effects of a supervised exercise training programme (SETP) on cardiac toxicity markers in women with breast cancer (BC) receiving anthracycline-containing chemotherapy.

METHODS AND RESULTS

Ninety-three women with early-stage breast cancer were randomly allocated to a supervised exercise training programme (SETP) plus usual care group (Exercise, n = 47) or usual care alone group (UC, n = 46). The SETP consisted of three sessions per week, combining aerobic and resistance training, conducted concurrently across the anthracycline-containing chemotherapy length. The primary endpoint was the change in left ventricular ejection fraction (LVEF) from baseline to the end of anthracycline cycles. Secondary endpoints included global longitudinal strain (GLS) and other conventional echocardiographic parameters, cardiorespiratory fitness (estimated peak VO2), circulating biomarkers (NT-proBNP, hs-TnT), and safety of the SETP. The study endpoints were also assessed 3 months after the end of anthracycline cycles. All patients were prescribed four cycles of doxorubicin plus cyclophosphamide (AC). No significant between-group differences in LVEF change were seen at the end of AC [mean difference: 0.7%; 95% confidence interval (CI): -0.8, 2.3; P = 0.349] and 3 months after AC (1.1%; 95% CI: -0.5, 2.6; P = 0.196). Compared to the usual care (UC) group, the estimated peak VO2 increased in the Exercise group at the end of AC (1.6 mL O2·kg-1·min-1; 95% CI: 0.06, 3.1; P = 0.041) and 3 months after AC (3.1 mL O2·kg-1·min-1; 95% CI: 1.4, 4.7; P < 0.001). No between-group differences were found in the remaining secondary endpoints. No serious adverse events were observed during SETP.

CONCLUSION

Exercise training was safe during chemotherapy and significantly improved cardiorespiratory fitness. No significant effects were seen on cardiac toxicity markers (LVEF or GLS) as compared to the usual care.

TRIAL REGISTRATION

Mama Move Gaia on treatment trial ISRCTN32617901.

摘要

目的

运动训练已被提议用于预防蒽环类药物相关的心脏功能障碍，但临床证据仍然有限。本研究旨在探讨监督运动训练计划（SETP）对接受含蒽环类药物化疗的乳腺癌（BC）女性的心脏毒性标志物的影响。

方法和结果

93 名早期乳腺癌女性被随机分配到监督运动训练计划（SETP）加常规护理组（运动组，n=47）或常规护理组（UC 组，n=46）。SETP 每周进行 3 次，结合有氧运动和阻力训练，在蒽环类药物化疗期间同时进行。主要终点是从基线到蒽环类药物周期结束时左心室射血分数（LVEF）的变化。次要终点包括整体纵向应变（GLS）和其他常规超声心动图参数、心肺功能（估计峰值 VO2）、循环生物标志物（NT-proBNP、hs-TnT）以及 SETP 的安全性。研究终点还在蒽环类药物周期结束后 3 个月进行评估。所有患者均接受 4 个周期的多柔比星加环磷酰胺（AC）治疗。在 AC 结束时[平均差异：0.7%；95%置信区间（CI）：-0.8，2.3；P=0.349]和 AC 结束后 3 个月[1.1%；95% CI：-0.5，2.6；P=0.196]，两组间 LVEF 变化无显著差异。与常规护理（UC）组相比，运动组在 AC 结束时[1.6 mL O2·kg-1·min-1；95% CI：0.06，3.1；P=0.041]和 AC 结束后 3 个月时[3.1 mL O2·kg-1·min-1；95% CI：1.4，4.7；P < 0.001]的估计峰值 VO2 增加。在其他次要终点方面，两组间无显著差异。SETP 期间未观察到严重不良事件。