Hazard-based risk grouping effectively stratifying breast cancer patients in post-irradiation long-term heart diseases: a population-based cohort study
BackgroundEven though advanced radiotherapy techniques provide a better protective effect on surrounding normal tissues, the late sequelae from radiation exposure to the heart are still considerable in breast cancer patients. The present population-based study explored the role of cox-regression-bas...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.980101/full |
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| author | Moon-Sing Lee Moon-Sing Lee Wei-Ta Tsai Wei-Ta Tsai Hsuan-Ju Yang Shih-Kai Hung Shih-Kai Hung Wen-Yen Chiou Wen-Yen Chiou Dai-Wei Liu Dai-Wei Liu Liang-Cheng Chen Liang-Cheng Chen Liang-Cheng Chen Chia-Hui Chew Ben-Hui Yu Feng-Chun Hsu Tung-Hsin Wu Hon-Yi Lin Hon-Yi Lin Hon-Yi Lin |
| author_facet | Moon-Sing Lee Moon-Sing Lee Wei-Ta Tsai Wei-Ta Tsai Hsuan-Ju Yang Shih-Kai Hung Shih-Kai Hung Wen-Yen Chiou Wen-Yen Chiou Dai-Wei Liu Dai-Wei Liu Liang-Cheng Chen Liang-Cheng Chen Liang-Cheng Chen Chia-Hui Chew Ben-Hui Yu Feng-Chun Hsu Tung-Hsin Wu Hon-Yi Lin Hon-Yi Lin Hon-Yi Lin |
| author_sort | Moon-Sing Lee |
| collection | DOAJ |
| description | BackgroundEven though advanced radiotherapy techniques provide a better protective effect on surrounding normal tissues, the late sequelae from radiation exposure to the heart are still considerable in breast cancer patients. The present population-based study explored the role of cox-regression-based hazard risk grouping and intended to stratify patients with post-irradiation long-term heart diseases.Materials and methodsThe present study investigated the Taiwan National Health Insurance (TNHI) database. From 2000 to 2017, we identified 158,798 breast cancer patients. Using a propensity score match of 1:1, we included 21,123 patients in each left and right breast irradiation cohort. Heart diseases, including heart failure (HF), ischemic heart disease (IHD), and other heart diseases (OHD), and anticancer agents, including epirubicin, doxorubicin, and trastuzumab, were included for analysis.ResultsPatients received left breast irradiation demonstrated increased risks on IHD (aHR, 1.16; 95% CI, 1.06–1.26; p < 0.01) and OHD (aHR, 1.08; 95% CI, 1.01–1.15; p < 0.05), but not HF (aHR, 1.11; 95% CI, 0.96–1.28; p = 0.14), when compared with patients received right breast irradiation. In patients who received left breast irradiation dose of >6,040 cGy, subsequent epirubicin might have a trend to increase the risk of heart failure (aHR, 1.53; 95% CI, 0.98–2.39; p = 0.058), while doxorubicin (aHR, 0.59; 95% CI, 0.26–1.32; p = 0.19) and trastuzumab (aHR, 0.93; 95% CI, 0.33–2.62; p = 0.89) did not. Older age was the highest independent risk factor for post-irradiation long-term heart diseases.ConclusionGenerally, systemic anticancer agents are safe in conjunction with radiotherapy for managing post-operative breast cancer patients. Hazard-based risk grouping may help stratify breast cancer patients associated with post-irradiation long-term heart diseases. Notably, radiotherapy should be performed cautiously for elderly left breast cancer patients who received epirubicin. Limited irradiation dose to the heart should be critically considered. Regular monitoring of potential signs of heart failure may be conducted. |
| first_indexed | 2024-04-09T15:45:45Z |
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| id | doaj.art-e2eb3c1e8f054235adebae3aa3677813 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-09T15:45:45Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-e2eb3c1e8f054235adebae3aa36778132023-04-27T04:49:13ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-04-011010.3389/fcvm.2023.980101980101Hazard-based risk grouping effectively stratifying breast cancer patients in post-irradiation long-term heart diseases: a population-based cohort studyMoon-Sing Lee0Moon-Sing Lee1Wei-Ta Tsai2Wei-Ta Tsai3Hsuan-Ju Yang4Shih-Kai Hung5Shih-Kai Hung6Wen-Yen Chiou7Wen-Yen Chiou8Dai-Wei Liu9Dai-Wei Liu10Liang-Cheng Chen11Liang-Cheng Chen12Liang-Cheng Chen13Chia-Hui Chew14Ben-Hui Yu15Feng-Chun Hsu16Tung-Hsin Wu17Hon-Yi Lin18Hon-Yi Lin19Hon-Yi Lin20Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, TaiwanDepartment of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanDepartments of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanDepartment of Computer Science and Information Engineering, National Cheng Kung University, Chiayi, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, TaiwanDepartment of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, TaiwanDepartment of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, TaiwanSchool of Medicine, Tzu Chi University, Hualien, TaiwanDepartment of Biomedical Sciences, National Chung Cheng University, Chia-Yi, TaiwanBackgroundEven though advanced radiotherapy techniques provide a better protective effect on surrounding normal tissues, the late sequelae from radiation exposure to the heart are still considerable in breast cancer patients. The present population-based study explored the role of cox-regression-based hazard risk grouping and intended to stratify patients with post-irradiation long-term heart diseases.Materials and methodsThe present study investigated the Taiwan National Health Insurance (TNHI) database. From 2000 to 2017, we identified 158,798 breast cancer patients. Using a propensity score match of 1:1, we included 21,123 patients in each left and right breast irradiation cohort. Heart diseases, including heart failure (HF), ischemic heart disease (IHD), and other heart diseases (OHD), and anticancer agents, including epirubicin, doxorubicin, and trastuzumab, were included for analysis.ResultsPatients received left breast irradiation demonstrated increased risks on IHD (aHR, 1.16; 95% CI, 1.06–1.26; p < 0.01) and OHD (aHR, 1.08; 95% CI, 1.01–1.15; p < 0.05), but not HF (aHR, 1.11; 95% CI, 0.96–1.28; p = 0.14), when compared with patients received right breast irradiation. In patients who received left breast irradiation dose of >6,040 cGy, subsequent epirubicin might have a trend to increase the risk of heart failure (aHR, 1.53; 95% CI, 0.98–2.39; p = 0.058), while doxorubicin (aHR, 0.59; 95% CI, 0.26–1.32; p = 0.19) and trastuzumab (aHR, 0.93; 95% CI, 0.33–2.62; p = 0.89) did not. Older age was the highest independent risk factor for post-irradiation long-term heart diseases.ConclusionGenerally, systemic anticancer agents are safe in conjunction with radiotherapy for managing post-operative breast cancer patients. Hazard-based risk grouping may help stratify breast cancer patients associated with post-irradiation long-term heart diseases. Notably, radiotherapy should be performed cautiously for elderly left breast cancer patients who received epirubicin. Limited irradiation dose to the heart should be critically considered. Regular monitoring of potential signs of heart failure may be conducted.https://www.frontiersin.org/articles/10.3389/fcvm.2023.980101/fullsynergic effectheart failurecardiovascular diseasebreast cancerepirubicinradiotherapy |
| spellingShingle | Moon-Sing Lee Moon-Sing Lee Wei-Ta Tsai Wei-Ta Tsai Hsuan-Ju Yang Shih-Kai Hung Shih-Kai Hung Wen-Yen Chiou Wen-Yen Chiou Dai-Wei Liu Dai-Wei Liu Liang-Cheng Chen Liang-Cheng Chen Liang-Cheng Chen Chia-Hui Chew Ben-Hui Yu Feng-Chun Hsu Tung-Hsin Wu Hon-Yi Lin Hon-Yi Lin Hon-Yi Lin Hazard-based risk grouping effectively stratifying breast cancer patients in post-irradiation long-term heart diseases: a population-based cohort study Frontiers in Cardiovascular Medicine synergic effect heart failure cardiovascular disease breast cancer epirubicin radiotherapy |
| title | Hazard-based risk grouping effectively stratifying breast cancer patients in post-irradiation long-term heart diseases: a population-based cohort study |
| title_full | Hazard-based risk grouping effectively stratifying breast cancer patients in post-irradiation long-term heart diseases: a population-based cohort study |
| title_fullStr | Hazard-based risk grouping effectively stratifying breast cancer patients in post-irradiation long-term heart diseases: a population-based cohort study |
| title_full_unstemmed | Hazard-based risk grouping effectively stratifying breast cancer patients in post-irradiation long-term heart diseases: a population-based cohort study |
| title_short | Hazard-based risk grouping effectively stratifying breast cancer patients in post-irradiation long-term heart diseases: a population-based cohort study |
| title_sort | hazard based risk grouping effectively stratifying breast cancer patients in post irradiation long term heart diseases a population based cohort study |
| topic | synergic effect heart failure cardiovascular disease breast cancer epirubicin radiotherapy |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.980101/full |
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