|
2018年5月8日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表韩国首尔高丽大学医学院九老医院的研究报告，通过韩国医疗保险审核评定机构数据库，对早期乳腺癌患者接受蒽环类化疗和（或）曲妥珠单抗治疗所致充血性心力衰竭的发生率、发生时间和风险因素进行了大数据分析。 该研究从韩国医疗保险审查评定机构数据库列入2007年1月～2016年10月被诊断为早期乳腺癌、既往无充血性心力衰竭史、年龄>19岁女性患者8万3544例。 结果发现充血性心力衰竭发生率：
术后辅助治疗至充血性心力衰竭发生的中位时间：
曲妥珠单抗治疗与充血性心力衰竭较早发生相关，无论之前化疗是否蒽环类，但是两个化疗组→曲妥珠单抗治疗后1.2年，充血性心力衰竭的远期风险迅速减少。 根据多因素比例风险回归分析，卡尔森合并症指数评分≥2的老年患者组（≥65岁）接受蒽环类→曲妥珠单抗后，充血性心力衰竭校正后风险比显著增加。 因此，该研究表明，对于韩国早期乳腺癌患者，无论之前化疗是否蒽环类，新辅助或辅助化疗→曲妥珠单抗与蒽环类化疗相比，充血性心力衰竭风险显著增加。 Breast Cancer Res Treat. 2018 May 8. [Epub ahead of print] Incidence and risk factors for congestive heart failure in patients with early breast cancer who received anthracycline and/or trastuzumab: a big data analysis of the Korean Health Insurance Review and Assessment service database. Jung Yoon Choi, Eun Young Cho, Yoon Ji Choi, Jeong Hyeon Lee, Seung Pil Jung, Kyu Ran Cho, Chul Yong Kim, Yeul Hong Kim, Kyong Hwa Park. Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea. PURPOSE: We aimed to analyze the incidence, time to occurrence, and congestive heart failure (CHF) risk factors for early breast cancer patients treated with anthracycline (AC)-based chemotherapy and/or trastuzumab (T) therapy in Korea. METHODS: We included female patients > 19 years old from the Health Insurance Review and Assessment Service database who had no prior CHF history and had been diagnosed with early breast cancer between January 2007 and October 2016. RESULTS: We included 83,544 patients in our analysis. In terms of crude incidence for CHF, AC followed by T showed the highest incidence (6.3%). However, 3.1 and 4.2% of the patients had CHF due to AC-based chemotherapy and non-AC followed by T, respectively. The median times to occurrence of CHF were different according to adjuvant treatments, approximately 2 years (701.0 days) in the AC-based chemotherapy group vs 1 year (377.5 days) AC followed by T group. T therapy was associated with earlier development of CHF irrespective of previous chemotherapy, but late risk of CHF 1.2 years after T therapy rapidly decreased in both chemotherapy groups. Multivariate Cox regression analysis revealed that the adjusted hazard ratio for CHF was increased in the group of older patients (≥ 65 years old) who underwent AC followed by T therapy, with Charlson comorbidity index scores of ≥ 2. CONCLUSIONS: Our study showed that neo-/adjuvant chemotherapy using T irrespective of previous chemotherapy (AC or non-AC) was associated with significantly increased risk of CHF compared with AC-based chemotherapy in Korean patients with early breast cancer. KEYWORDS: Congestive heart failure; Anthracycline; Trastuzumab; Breast cancer DOI: 10.1007/s10549-018-4809-8 |
|
|
