Long-Term Cardiovascular Risk After Radiotherapy in Women With Breast Cancer.
Long-Term Cardiovascular Risk After Radiotherapy in Women With Breast Cancer.
复制标题
乳腺癌女性放射治疗后的长期心血管风险
DOI：
10.1161/jaha.117.005633
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发表时间：
2017-05-21
影响因子：
5.4
通讯作者：
Wu SH
中科院分区：
文献类型：
--
作者：
Cheng YJ;Nie XY;Ji CC;Lin XX;Liu LJ;Chen XM;Yao H;Wu SH
乳腺癌的放射治疗通常涉及心脏偶然暴露于电离辐射。这种暴露对随后患心脏病风险的影响尚不确定。我们进行了一项Meta分析，以研究乳腺癌患者放疗与长期心血管发病率和死亡率之间的联系。我们使用MEDLINE（1966年1月至2015年1月）和EMBASE（1980年1月至2015年1月）进行了文献检索，无限制。纳入了报告相关性的相对风险（RR）估计值和95%CI的研究。使用随机效应Meta分析获得合并效应估计值。确定了39项研究，涉及1 191 371名受试者。与接受右侧放疗的患者相比，接受左侧放疗的患者发生冠心病（RR 1.29，95%CI 1.13 - 1.48）、心源性死亡（RR 1.22，95%CI 1.08 - 1.37）和全因死亡（RR 1.05，95%CI 1.01 - 1.10）的风险增加。在接受放疗和未接受放疗患者的比较中，冠心病的RR为1.30（95%CI 1.13 - 1.49），心源性死亡率为1.38（95%CI 1.18 - 1.62）。乳腺癌放疗与每10万人年76.4例（95%CI 36.8 - 130.5）冠心病和125.5例（95%CI 98.8 - 157.9）心源性死亡的绝对风险增加相关。在第一个十年内，冠心病的风险开始增加，从第二个十年开始，心脏病死亡率开始增加。在乳腺癌放射治疗期间心脏暴露于电离辐射会增加随后患冠心病和心源性死亡的风险。
Radiotherapy for breast cancer often involves some incidental exposure of the heart to ionizing radiation. The effect of this exposure on the subsequent risk of heart disease is uncertain. We performed a meta‐analysis to investigate the link between radiotherapy and long‐term cardiovascular morbidity and mortality in patients with breast cancer. We performed a literature search using MEDLINE (January 1966 to January 2015) and EMBASE (January 1980 to January 2015) with no restrictions. Studies that reported relative risk (RR) estimates with 95%CIs for the associations of interest were included. Pooled effect estimates were obtained by using random‐effects meta‐analysis. Thirty‐nine studies involving 1 191 371 participants were identified. Patients who received left‐sided radiotherapy, as compared with those receiving right‐sided radiotherapy, experienced increased risks of developing coronary heart disease (RR 1.29, 95%CI 1.13‐1.48), cardiac death (RR 1.22, 95%CI 1.08‐1.37) and death from any cause (RR 1.05, 95%CI 1.01‐1.10). In a comparison of patients with radiotherapy and without radiotherapy, the RRs were 1.30 (95%CI 1.13‐1.49) for coronary heart disease and 1.38 (95%CI 1.18‐1.62) for cardiac mortality. Radiotherapy for breast cancer was associated with an absolute risk increase of 76.4 (95%CI 36.8‐130.5) cases of coronary heart disease and 125.5 (95%CI 98.8‐157.9) cases of cardiac death per 100 000 person‐years. The risk started to increase within the first decade for coronary heart disease and from the second decade for cardiac mortality. Exposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent risk of coronary heart disease and cardiac mortality.