Tjong M C, Zhang S C, Gasho J O, Silos K D, Gay C, McKenzie E M, Steers J, Bitterman D S, Nikolova A P, Nohria A, Hoffmann U, Brantley K D, Mak R H, Atkins K M
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, United States.
Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Clin Transl Radiat Oncol. 2023 Jul 24;42:100660. doi: 10.1016/j.ctro.2023.100660. eCollection 2023 Sep.
Major adverse cardiac events(MACE) are prevalent in patients with locally advanced-non-small cell lung cancer(LA-NSCLC) following radiotherapy(RT). The model, incorporating coronary heart disease(HD),pertension(HTN),ogarithmic ADV15 was developed and internally-validated to predict MACE among LA-NSCLC patients. We sought to externally validate CHyLL to predict MACE in an independent LA-NSCLC cohort.
Patients with LA-NSCLC treated with RT were included. CHyLL score was calculated:5.51CHD + 1.28HTN + 1.48ln(LADV15 + 1)-1.36CHD*ln(LADV15 + 1). CHyLL performance in predicting MACE was assessed and compared to mean heart dose(MHD) using Cox-proportional hazard(PH) analyses and Harrel's concordance(C)-indices. MACE and overall survival(OS) among low-vs high-risk groups(CHyLL < 5 vs ≥ 5) were compared.
In the external validation cohort(N = 102), the median age was 71 years and 55% were females. Most(n = 74,73%), had clinical Stage III disease and 35(34%) underwent surgery. CHyLL demonstrated good MACE prediction with C-index of 0.73(95% Confidence Interval(CI):0.58-0.89), while MHD did not (C-index = 0.46 (95% CI:0.30-0.62)). Per CHyLL, 32(31%) and 70(69%) patients were considered low-and high-risk for MACE, respectively. CHyLL consistently identified lower MACE rates in the low-vs high-risk group(log-rank p = 0.108):0 vs 8%(12 months),5 vs 16%(24 months),5 vs 16%(36 months),and 5 vs 19%(48 months) post-RT. In the pooled internal and external validation cohort(N = 303), MACE rates in low-vs high-risk groups were statistically significantly different(log-rank p = 0.01):1 vs 6%(12 months),3 vs 12%(24 months),6 vs 19%(36 months),and 6 vs 21%(48 months).
CHyLL was externally validated and superior to MHD in predicting MACE. CHyLL has the potential to identify high-risk patients who may benefit from cardio-oncology optimization and to estimate personalized LADV15 constraints based on cardiac risk factors and acceptable MACE thresholds.
在接受放疗（RT）的局部晚期非小细胞肺癌（LA - NSCLC）患者中，主要不良心脏事件（MACE）很常见。开发并进行内部验证了包含冠心病（HD）、高血压（HTN）、对数化ADV15的模型，以预测LA - NSCLC患者中的MACE。我们试图在一个独立的LA - NSCLC队列中对CHyLL进行外部验证，以预测MACE。
纳入接受RT治疗的LA - NSCLC患者。计算CHyLL评分：5.51×冠心病 + 1.28×高血压 + 1.48×ln（ADV15 + 1） - 1.36×冠心病×ln（ADV15 + 1）。使用Cox比例风险（PH）分析和Harrel一致性（C）指数评估CHyLL在预测MACE方面的表现，并与平均心脏剂量（MHD）进行比较。比较低风险组与高风险组（CHyLL < 5 vs ≥ 5）中的MACE和总生存期（OS）。
在外部验证队列（N = 102）中，中位年龄为71岁，55%为女性。大多数（n = 74，73%）为临床III期疾病，35例（34%）接受了手术。CHyLL在预测MACE方面表现良好，C指数为0.73（95%置信区间（CI）：0.58 - 0.89），而MHD则不然（C指数 = 0.46（95% CI：0.30 - 0.62））。根据CHyLL，分别有32例（31%）和70例（69%）患者被认为MACE低风险和高风险。CHyLL始终显示低风险组的MACE发生率低于高风险组（对数秩p = 0.108）：放疗后12个月为0% vs 8%，24个月为5% vs 16%，36个月为5% vs 16%，48个月为5% vs 19%。在汇总的内部和外部验证队列（N = 303）中，低风险组与高风险组的MACE发生率在统计学上有显著差异（对数秩p = 0.01）：12个月时为1% vs 6%，24个月时为3% vs 12%，36个月时为6% vs 19%，48个月时为6% vs 21%。
CHyLL在预测MACE方面经过了外部验证，且优于MHD。CHyLL有潜力识别可能从心脏肿瘤学优化中获益的高风险患者，并根据心脏危险因素和可接受的MACE阈值估计个性化的ADV15限制。
