Koop Yvonne, Atsma Femke, Batenburg Marilot C T, Meijer Hanneke, van der Leij Femke, Gal Roxanne, van Velzen Sanne G M, Išgum Ivana, Vermeulen Hester, Maas Angela H E M, Messaoudi Saloua El, Verkooijen Helena M
Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
Julius Centre for Health Sciences and Primary Care, Cardiovascular Epidemiology, Utrecht Medical Centre, Utrecht University, Att. Yvonne Koop, str 6.131, P.O. Box 85500, Utrecht, 3508 GA, The Netherlands.
Cardiooncology. 2024 Feb 9;10(1):7. doi: 10.1186/s40959-024-00206-4.
Thoracic radiotherapy may damage the myocardium and arteries, increasing cardiovascular disease (CVD) risk. Women with a high local breast cancer (BC) recurrence risk may receive an additional radiation boost to the tumor bed.
We aimed to evaluate the CVD risk and specifically ischemic heart disease (IHD) in BC patients treated with a radiation boost, and investigated whether this was modified by age.
We identified 5260 BC patients receiving radiotherapy between 2005 and 2016 without a history of CVD. Boost data were derived from hospital records and the national cancer registry. Follow-up data on CVD events were obtained from Statistics Netherlands until December 31, 2018. The relation between CVD and boost was evaluated with competing risk survival analysis.
1917 (36.4%) received a boost. Mean follow-up was 80.3 months (SD37.1) and the mean age 57.8 years (SD10.7). Interaction between boost and age was observed for IHD: a boost was significantly associated with IHD incidence in patients younger than 40 years but not in patients over 40 years. The subdistribution hazard ratio (sHR) was calculated for ages from 25 to 75 years, showing a sHR range from 5.1 (95%CI 1.2-22.6) for 25-year old patients to sHR 0.5 (95%CI 0.2-1.02) for 75-year old patients.
In patients younger than 40, a radiation boost is significantly associated with an increased risk of CVD. In absolute terms, the increased risk was low. In older patients, there was no association between boost and CVD risk, which is likely a reflection of appropriate patient selection.
胸部放疗可能会损伤心肌和动脉，增加心血管疾病（CVD）风险。局部乳腺癌（BC）复发风险高的女性可能会接受额外的瘤床放疗。
我们旨在评估接受瘤床放疗的BC患者的CVD风险，尤其是缺血性心脏病（IHD），并研究年龄是否会对此产生影响。
我们确定了2005年至2016年间接受放疗且无CVD病史的5260例BC患者。瘤床放疗数据来自医院记录和国家癌症登记处。直到2018年12月31日，CVD事件的随访数据来自荷兰统计局。采用竞争风险生存分析评估CVD与瘤床放疗之间的关系。
1917例（36.4%）接受了瘤床放疗。平均随访时间为80.3个月（标准差37.1），平均年龄为57.8岁（标准差10.7）。观察到瘤床放疗与年龄之间在IHD方面存在交互作用：瘤床放疗与40岁以下患者的IHD发病率显著相关，但与40岁以上患者无关。计算了25岁至75岁年龄段的亚分布风险比（sHR），显示25岁患者的sHR范围为5.1（95%置信区间1.2 - 22.6），75岁患者的sHR为0.5（95%置信区间0.2 - 1.02）。
在40岁以下患者中，瘤床放疗与CVD风险增加显著相关。就绝对风险而言，增加的风险较低。在老年患者中，瘤床放疗与CVD风险之间无关联，这可能反映了适当的患者选择。
