Chi Kaiyi, Luo Zehao, Zhao Hongjun, Li Yemin, Liang Yinglan, Xiao Zhaoling, He Yiru, Zhang Hanbin, Ma Zaiying, Zeng Liangjia, Zhou Ruoyun, Feng Manting, Li Wangen, Rao Huying, Yi Min
Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Clinical Medicine, The Second Clinical College of Guangzhou Medical University, Guangzhou, China.
Front Cardiovasc Med. 2023 May 9;10:1149633. doi: 10.3389/fcvm.2023.1149633. eCollection 2023.
Previous studies focused on the impact of cardiovascular diseases (CVD) risk factors in breast cancer patients with chemotherapy (CT) or radiotherapy (RT). This study aimed to identify the impact of tumor characteristics on CVD death in these patients.
Data of female breast cancer patients with CT or RT between 2004 and 2016 were included. The risk factors of CVD death were identified using Cox regression analyses. A nomogram was constructed to evaluate the predicted value of tumor characteristics, and then validated by the concordance indexes (C-index) and calibration curves.
A total of 28,539 patients were included with an average follow-up of 6.1 years. Tumor size > 45 mm (adjusted HR = 1.431, 95% CI = 1.116-1.836, = 0.005), regional (adjusted HR = 1.278, 95% CI = 1.048-1.560, = 0.015) and distant stage (adjusted HR = 2.240, 95% CI = 1.444-3.474, < 0.001) were risk factors of CVD death for breast cancer patients with CT or RT. The prediction nomogram of tumor characteristics (tumor size and stage) on CVD survival was established. The C-index of internal and external validation were 0.780 (95% Cl = 0.751-0.809), and 0.809 (95% Cl = 0.768-0.850), respectively. The calibration curves showed consistency between the actual observation and nomogram. The risk stratification was also significant distinction ( < 0.05).
Tumor size and stage were related to the risk of CVD death for breast cancer patients with CT or RT. The management of CVD death risk in breast cancer patients with CT or RT should focus not only on CVD risk factors but also on tumor size and stage.
既往研究主要关注心血管疾病（CVD）风险因素对接受化疗（CT）或放疗（RT）的乳腺癌患者的影响。本研究旨在确定肿瘤特征对这些患者CVD死亡的影响。
纳入2004年至2016年间接受CT或RT的女性乳腺癌患者的数据。使用Cox回归分析确定CVD死亡的风险因素。构建列线图以评估肿瘤特征的预测价值，然后通过一致性指数（C指数）和校准曲线进行验证。
共纳入28539例患者，平均随访6.1年。肿瘤大小>45 mm（调整后HR = 1.431，95%CI = 1.116 - 1.836，P = 0.005）、区域分期（调整后HR = 1.278，95%CI = 1.048 - 1.560，P = 0.015）和远处分期（调整后HR = 2.240，95%CI = 1.444 - 3.474，P < 0.001）是接受CT或RT的乳腺癌患者CVD死亡的风险因素。建立了肿瘤特征（肿瘤大小和分期）对CVD生存的预测列线图。内部和外部验证的C指数分别为0.780（95%CI = 0.751 - 0.809）和0.809（95%CI = 0.768 - 0.850）。校准曲线显示实际观察值与列线图之间具有一致性。风险分层也有显著差异（P < 0.05）。
肿瘤大小和分期与接受CT或RT的乳腺癌患者的CVD死亡风险相关。对接受CT或RT的乳腺癌患者CVD死亡风险的管理不仅应关注CVD风险因素，还应关注肿瘤大小和分期。
