Lee Moon-Sing, Tsai Wei-Ta, Yang Hsuan-Ju, Hung Shih-Kai, Chiou Wen-Yen, Liu Dai-Wei, Chen Liang-Cheng, Chew Chia-Hui, Yu Ben-Hui, Hsu Feng-Chun, Wu Tung-Hsin, Lin Hon-Yi
Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Front Cardiovasc Med. 2023 Apr 27;10:980101. doi: 10.3389/fcvm.2023.980101. eCollection 2023.
Even though advanced radiotherapy techniques provide a better protective effect on surrounding normal tissues, the late sequelae from radiation exposure to the heart are still considerable in breast cancer patients. The present population-based study explored the role of cox-regression-based hazard risk grouping and intended to stratify patients with post-irradiation long-term heart diseases.
The present study investigated the Taiwan National Health Insurance (TNHI) database. From 2000 to 2017, we identified 158,798 breast cancer patients. Using a propensity score match of 1:1, we included 21,123 patients in each left and right breast irradiation cohort. Heart diseases, including heart failure (HF), ischemic heart disease (IHD), and other heart diseases (OHD), and anticancer agents, including epirubicin, doxorubicin, and trastuzumab, were included for analysis.
Patients received left breast irradiation demonstrated increased risks on IHD (aHR, 1.16; 95% CI, 1.06-1.26; < 0.01) and OHD (aHR, 1.08; 95% CI, 1.01-1.15; < 0.05), but not HF (aHR, 1.11; 95% CI, 0.96-1.28; = 0.14), when compared with patients received right breast irradiation. In patients who received left breast irradiation dose of >6,040 cGy, subsequent epirubicin might have a trend to increase the risk of heart failure (aHR, 1.53; 95% CI, 0.98-2.39; = 0.058), while doxorubicin (aHR, 0.59; 95% CI, 0.26-1.32; = 0.19) and trastuzumab (aHR, 0.93; 95% CI, 0.33-2.62; = 0.89) did not. Older age was the highest independent risk factor for post-irradiation long-term heart diseases.
Generally, systemic anticancer agents are safe in conjunction with radiotherapy for managing post-operative breast cancer patients. Hazard-based risk grouping may help stratify breast cancer patients associated with post-irradiation long-term heart diseases. Notably, radiotherapy should be performed cautiously for elderly left breast cancer patients who received epirubicin. Limited irradiation dose to the heart should be critically considered. Regular monitoring of potential signs of heart failure may be conducted.
尽管先进的放射治疗技术对周围正常组织具有更好的保护作用，但乳腺癌患者因辐射暴露对心脏造成的晚期后遗症仍然相当严重。本基于人群的研究探讨了基于 Cox 回归的风险分组的作用，并旨在对放疗后患有长期心脏病的患者进行分层。
本研究调查了台湾国民健康保险（TNHI）数据库。2000 年至 2017 年期间，我们确定了 158,798 例乳腺癌患者。通过 1:1 的倾向得分匹配，我们在左乳照射队列和右乳照射队列中各纳入了 21,123 例患者。分析包括心脏病，如心力衰竭（HF）、缺血性心脏病（IHD）和其他心脏病（OHD），以及抗癌药物，如表柔比星、多柔比星和曲妥珠单抗。
与接受右乳照射的患者相比，接受左乳照射的患者患 IHD（风险比[HR]，1.16；95%可信区间[CI]，1.06 - 1.26；P < 0.01）和 OHD（HR，1.08；95%CI，1.01 - 1.15；P < 0.05）的风险增加，但患 HF 的风险未增加（HR，1.11；95%CI，0.96 - 1.28；P = 0.14）。在接受左乳照射剂量 >6,040 cGy 的患者中，后续使用表柔比星可能有增加心力衰竭风险的趋势（HR，1.53；95%CI，0.98 - 2.39；P = 0.058），而多柔比星（HR，0.59；95%CI，0.26 - 1.32；P = 0.19）和曲妥珠单抗（HR，0.93；95%CI，0.33 - 2.62；P = 0.89）则没有。年龄较大是放疗后长期心脏病的最高独立危险因素。
一般来说，全身抗癌药物与放疗联合用于治疗术后乳腺癌患者是安全的。基于风险的分组可能有助于对放疗后患有长期心脏病的乳腺癌患者进行分层。值得注意的是，对于接受表柔比星治疗的老年左乳癌患者，放疗应谨慎进行。应严格考虑对心脏的有限照射剂量。可定期监测心力衰竭的潜在迹象。
