Association of Early-Stage Breast Cancer and Subsequent Chemotherapy With Risk of Atrial Fibrillation
Association of Early-Stage Breast Cancer and Subsequent Chemotherapy With Risk of Atrial Fibrillation
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DOI：
10.1001/jamanetworkopen.2019.11838
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发表时间：
2019-09-01
影响因子：
13.8
通讯作者：
Lee, Douglas S.
中科院分区：
文献类型：
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作者：
Abdel-Qadir, Husam;Thavendiranathan, Paaladinesh;Lee, Douglas S.
重要性几种类型的癌症与发生房颤（AF）的风险较高有关。关于早期乳腺癌（EBC）的数据较少，而EBC的心脏肿瘤学问题更相关。目的研究EBC和随后的化疗与发生AF的风险之间的关系。设计、设置和参与者这是一项在加拿大安大略多伦多进行的基于人群的回顾性匹配队列研究。在2007年4月至2016年12月期间诊断为EBC的68113名女性中，根据出生年份和接受乳房成像，将其与无癌症对照组1：3匹配。使用McNemar检验比较队列之间索引日期（EBC诊断日期）之前的AF患病率。累积发生率函数曲线用于描述AF发生率。为了研究既存AF，在排除既往AF之前匹配参与者。对于其余分析，我们在匹配之前排除了既往AF的女性。在索引日期后1年开始进行分析（即，排除第1年的AF诊断），我们按化疗暴露进行分层。采用多变量原因特异性回归分析确定EBC相对于对照组的风险比（HR）以及EBC患者化疗与AF的相关性。两组的平均（SD）年龄为60（13）岁。在患有EBC的女性中，44.3%被诊断为I期乳腺癌; 38.7%，II期; 13.4%，III期; 3.6%的患者癌症分期信息缺失。既存AF患病率无差异（EBC队列为5.3%，对照组为5.2%; P = 0.21）。在索引日期后10年，EBC女性的AF发生率为7.4%（95%CI，7.1%-7.7%），对照组为6.8%（95%CI，6.7%-7.0%）（P
IMPORTANCE Several types of cancer have been linked to a higher risk of developing atrial fibrillation (AF). Fewer data exist regarding early-stage breast cancer (EBC), for which cardiooncology concerns are more pertinent.OBJECTIVE To investigate the association of EBC and subsequent chemotherapy with the risk of developing AF.DESIGN, SETTING, AND PARTICIPANTS This was a population-based, retrospective, matched cohort study conducted in Toronto, Ontario, Canada, of 68 113 women diagnosed with EBC between April 2007 and December 2016 whowere matched 1: 3 to a cancer-free control group based on birth year and receipt of breast imaging. Prevalence of AF before the index date (date of EBC diagnosis) was compared between the cohorts using the McNemar test. Cumulative incidence function curves were used to describe the AF incidence. To study preexisting AF, participants were matched before exclusion for prior AF. For the remaining analyses, we excluded women with prior AF before matching. An analysis was conducted beginning 1 year after the index date (ie, excluding AF diagnoses in year 1), which we stratified by chemotherapy exposure. Multivariable cause-specific regression was used to determine the hazard ratio (HR) associated with EBC relative to the controls and the association of chemotherapy with AF in patients with EBC.EXPOSURES Breast cancer and chemotherapy.MAIN OUTCOMES AND MEASURES Incidence of AF.RESULTS A total of 68 113 women with EBC and 204 330 cancer-free controls were included in the study; both groups had a mean (SD) age of 60 (13) years. Of the women with EBC, 44.3% were diagnosed as having stage I breast cancer; 38.7%, stage II; and 13.4%, stage III; cancer stage information was missing for 3.6% of the patients. No difference was observed in preexisting AF prevalence (5.3% in the EBC cohort vs 5.2% in controls; P =.21). At 10 years after the index date, the AF incidence was 7.4%(95% CI, 7.1%-7.7%) for women with EBC and 6.8%(95% CI, 6.7%-7.0%) for the controls (P