Doxorubicin-induced heart failure in cancer patients: A cohort study based on the Korean National Health Insurance Database
Doxorubicin-induced heart failure in cancer patients: A cohort study based on the Korean National Health Insurance Database
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DOI：
10.1002/cam4.1886
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发表时间：
2018-12-01
期刊：
影响因子：
4
通讯作者：
Kim, Hak Jin
中科院分区：
文献类型：
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作者：
Kim, Young Ae;Cho, Hyunsoon;Kim, Hak Jin
背景阿霉素是一种典型的抗肿瘤药物，可引起心肌病和心力衰竭（HF）。本研究的目的是调查韩国癌症患者多柔比星诱导的HF的发病率、危险因素及其生存率，采用全国范围的人群队列研究。方法我们分析了2003年至2010年期间接受阿霉素治疗的58 541例癌症患者。对乳腺癌、血液系统恶性肿瘤、妇科恶性肿瘤和肉瘤患者进行描述性分析。使用考克斯比例风险模型研究与多柔比星诱导的HF相关的风险因素。比较多柔比星诱导的HF患者的生存率与无多柔比星诱导的HF患者的生存率。结果2324例（4%）被诊断为多柔比星诱导的HF。在乳腺癌患者中，多柔比星诱导HF的预测风险因素包括年龄超过65岁[风险比（HR）1.34，95%置信区间（CI）1.05-1.72]，高血压[HR 2.45（2.12- 2.84）]、糖尿病[HR 1.26（1.05-1.51）]、冠心病[HR 2.08（1.63-2.66）]、晚期[HR 1.31（1.13-1.50）]和曲妥珠单抗给药[HR 2.94（2.54-3.40）]。在恶性血液病患者中，预测风险因素包括年龄超过65岁[HR 1.75（1.49-2.07）]、高血压[HR 1.62（1.37-1.92）]和冠状动脉疾病[HR 2.28（1.80-2.89）]。乳腺癌和恶性血液病患者中，多柔比星诱导的HF患者的5年生存率明显低于无HF患者：分别为80%和84%，69%和75%（P < 0.001）。结论：在接受阿霉素治疗的癌症患者中，风险因素的管理、早期发现和治疗阿霉素诱导的HF可能对患者生存至关重要。
Background Doxorubicin is a typical anticancer drug that causes cardiomyopathy and heart failure (HF). The aim of our study was to investigate incidence, risk factors for doxorubicin-induced HF in Korean cancer patients and their survival rate, utilizing a nationwide population-based cohort. Methods We analyzed 58 541 cancer patients who received doxorubicin between 2003 and 2010. Descriptive analysis was performed in patients with breast cancer, hematologic malignancy, gynecological malignancy, and sarcoma. Risk factors associated with doxorubicin-induced HF were investigated using a Cox proportional hazards model. The survival rate of doxorubicin-induced HF patients was compared with that of patients without doxorubicin-induced HF. Results A total of 2324 (4%) were diagnosed with doxorubicin-induced HF. In patients with breast cancer, predictive risk factors for doxorubicin-induced HF included age over 65 years [hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.05-1.72], hypertension [HR 2.45 (2.12- 2.84)], diabetes mellitus [HR 1.26 (1.05-1.51)], coronary artery disease [HR 2.08 (1.63-2.66)], advanced stage [HR 1.31 (1.13-1.50)], and trastuzumab administration [HR 2.94 (2.54-3.40)]. In patients with hematologic malignancy, predictive risk factors included age over 65 years [HR 1.75 (1.49-2.07)], hypertension [HR 1.62 (1.37-1.92)], and coronary artery disease [HR 2.28 (1.80-2.89)]. Five-year survival rates of patients with doxorubicin-induced HF were significantly lower relative to those of patients without HF in breast cancer and hematologic malignancy: 80% vs 84% and 69% vs 75%, respectively (P < 0.001). Conclusions In cancer patients treated with doxorubicin, management of risk factors, early detection, and treatment for doxorubicin-induced HF might be critical for patient survival.