摘要
目的评估表柔比星/环磷酰胺-多西他赛-曲妥珠单抗(EC-D-T)辅助治疗HER-2阳性乳腺癌患者的心脏毒性及生长分化因子15(GDF-15)对其心脏毒性发生风险的预测作用。方法纳入2014年1月-2016年12月手术后接受EC-D-T辅助治疗的73例HER-2阳性乳腺癌患者。于辅助治疗前(M0)、辅助治疗后第3(M3)、6(M6)、9(M9)、12(M12)和15个月(M15)检测患者血清GDF-15、心肌肌钙蛋白I(cTnI)和氨基末端脑钠肽前体(NT-proBNP)水平。同时,患者在各时间点接受心脏超声检查并通过超声心动图评估左心室射血分数(LVEF)。结果启动EC-D-T治疗后,LVEF水平逐渐降低。整个研究过程中,共21(28.8%)例患者发生了心脏毒性,同时,发生心脏毒性患者在M0的GDF-15水平及各个时间点的cTnl水平显著高于未发生心脏毒性患者,而NT-proBNP水平和未发生心脏毒性患者相当。此外,单因素Logistic回归显示基线期GDF-15可能是接受EC-D-T治疗的HER-2阳性乳腺癌患者心脏毒性的影响因素,多因素Logistic回归分析表明仅有cTnl水平是接受EC-D-T治疗的HER-2阳性乳腺癌患者出现心脏毒性的独立预测因素,而NT-proBNP水平不可预测心脏毒性发生风险。结论 HER-2阳性乳腺癌患者接受EC-D-T治疗后的心脏毒性发生率高,而GDF-15可以预测及监控心脏毒性的发生风险。
Objective The aim of current study was to evaluate the effect of growth differentiation factor 15(GDF-15)on predicting and monitoring the cardiotoxicity of epirubicin/cyclophosphamide-docetaxel-trastuzumab(EC-D-T)in the treatment of HER-2 positive breast cancer patients.Methods Seventy-three patients with HER-2 positive breast cancer who received EC-D-T adjuvant therapy were enrolled.Serum levels of GDF-15,cardiac troponin I(cTnl)and amino terminal brain natriuretic peptide precursor(NT-proBNP)were measured before adjuvant therapy(M0)and after adjuvant therapy at 3 months(M3),6 months(M6),9 months(M9),12 months(M12)and 15 months(M15).At the same time,patients underwent echocardiography at various time points to assess the left ventricular ejection fraction(LVEF).The cardiotoxicity of this study was defined as:(1)LVEF level decreased by ≥10% after treatment and the absolute value of LVEF was below 53%(normal);(2)heart failure,acute coronary syndrome or severe life-threatening heart rate abnormal.Results After initiation of EC-D-T treatment,the level of LVEF gradually decreased.During the whole study,a total of 21(28.8%)patients developed cardiotoxicity.At the same time,patients with cardiotoxicity had significantly higher levels of GDF-15 at M0 and cTn1 at various time points than those without cardiotoxicity.The level of ProBNP was comparable to those without cardiotoxicity.In addition,Univariate logistic regression analysis showed that baseline GDF-15 might affect the risk of cardiotoxicity. Multivariate logistic regression analysis showed that only cTnl level was an independent predictor for the risk of cardiotoxicity, while NT-proBNP level did not predict the risk of cardiotoxicity. Conclusion The incidence of cardiotoxicity in patients with HER-2 positive breast cancer after receiving EC-D-T is high,and GDF-15 can predict and monitor the risk of cardiotoxicity.
作者
胡琳
沈佳
HU Lin;SHEN Jia(Department of Pharmacy,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《实用肿瘤学杂志》
CAS
2019年第4期340-345,共6页
Practical Oncology Journal
