蒽环类药物序贯曲妥珠单抗治疗导致乳腺癌患者心脏毒性的相关危险因素研究

Risk Factors of Cardiotoxicity in Patients with Breast Cancer After Sequential Trastuzumab Therapy with Anthracyclines

目的:探讨蒽环类药物序贯曲妥珠单抗治疗导致乳腺癌患者心脏毒性的相关危险因素。方法:选择2017年4月至2020年1月该院采用蒽环类药物序贯曲妥珠单抗治疗的乳腺癌患者169例,观察其心脏毒性发生情况,分为心脏毒性组与非心脏毒性组。记录并分析两组患者的年龄、体重指数、肿瘤分期、高血压史、糖尿病史、高脂血症史、联合放疗和蒽环类药物种类等因素的差异。通过Logistic回归,分析蒽环类药物序贯曲妥珠单抗治疗后乳腺癌患者出现心脏毒性的危险因素。结果:169例采用蒽环类药物序贯曲妥珠单抗治疗的乳腺癌患者中,发生心脏毒性患者57例,心脏毒性发生率为33.73%。心脏毒性组与非心脏毒性组患者在高脂血症史、联合放疗和蒽环类药物种类方面的差异均有统计学意义(P<0.05)。进一步分析发现,相对于无高脂血症的患者,高脂血症患者发生心脏毒性的风险增加(OR=5.068,95%CI=2.209~11.628);相对于无联合放疗的患者,左胸放疗患者发生心脏毒性的风险增加(OR=3.734,95%CI=1.448~9.628);相对于使用表柔比星治疗的患者,使用吡柔比星治疗的患者发生心脏毒性的风险更小(OR=0.407,95%CI=0.182~0.911)。结论:采用蒽环类药物序贯曲妥珠单抗治疗的乳腺癌患者心脏毒性发生率较高。表柔比星治疗、高脂血症史和左胸放疗史是蒽环类药物序贯曲妥珠单抗治疗导致乳腺癌患者心脏毒性的独立危险因素。

OBJECTIVE:To probe into the related risk factors of cardiotoxicity in patients with breast cancer after sequential trastuzumab therapy with anthracyclines.METHODS:Totally 169 patients with breast cancer undergoing sequential trastuzumab therapy with anthracyclines in this hospital from Apr.2017 to Jan.2020 were extracted to be divided into the cardiotoxicity group and the non-cardiotoxicity group according to the incidence of cardiotoxicity.The age,body mass index,tumor stage,history of hypertension,history of diabetes,history of hyperlipidemia,combined radiotherapy,categories of anthracyclines and other factors of two groups of patients were recorded and analyzed.Risk factors of cardiotoxicity in patients with breast cancer after sequential trastuzumab therapy with anthracyclines were analyzed by logistic regression.RESULTS:Among 169 patients with breast cancer after sequential trastuzumab therapy with anthracyclines,57 patients developed cardiotoxicity,with the incidence of 33.73%.There were statistically significant differences between the cardiotoxicity group and the non-cardiotoxicity group in the history of hyperlipidemia,combined radiotherapy and categories of anthracyclines(P<0.05).Further analysis showed that patients with hyperlipidemia had an increased risk of cardiotoxicity compared with those without hyperlipidemia(OR=5.068,95%CI=2.209-11.628).Patients treated with left thoracic radiotherapy had an increased risk of cardiotoxicity compared with those without combined radiotherapy(OR=3.734,95%CI=1.448-9.628).Compared with patients received epirubicin,patients received pirarubicin had a lower risk of cardiotoxicity(OR=0.407,95%CI=0.182-0.911).CONCLUSIONS:The incidence of cardiotoxicity in patients with breast cancer after sequential trastuzumab therapy with anthracyclines is higher.Treatment with epirubicin,history of hyperlipidemia and history of left thoracic radiotherapy are independent risk factors for cardiotoxicity in patients with breast cancer after sequential trastuzumab therapy with anthracyclines.