Cardiac Radiation Dose, Cardiac Disease, and Mortality in Patients With Lung Cancer
Cardiac Radiation Dose, Cardiac Disease, and Mortality in Patients With Lung Cancer
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DOI：
10.1016/j.jacc.2019.03.500
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发表时间：
2019-06-18
影响因子：
24
通讯作者：
Mak, Raymond H.
中科院分区：
文献类型：
--
作者：
Atkins, Katelyn M.;Rawal, Bhupendra;Mak, Raymond H.
背景局部晚期非小细胞肺癌（NSCLC）患者的放射治疗相关心脏毒性研究受到样本量小和未经验证的心脏终点的限制。本分析的目的是确定心脏放射剂量是否是主要不良心脏事件（MACE）和全因死亡率（ACM）的预测因子。方法回顾性分析748例接受胸部放疗的局部晚期NSCLC患者。Fine和Gray以及考克斯回归分析用于确定MACE和ACM的预测因子，调整肺癌和心血管预后因素，包括预先存在的冠心病（CHD）。（2年累积发病率，5.8%; 95%置信区间[CI]：4.3%至7.7%），533人死亡。输送至心脏的平均辐射剂量（平均心脏剂量）与MACE风险显著增加相关（校正风险比[HR]：1.05/戈伊; 95% CI：1.02 - 1.08/戈伊; p= 10戈伊vs.
BACKGROUND Radiotherapy-associated cardiac toxicity studies in patients with locally advanced non-small cell lung cancer (NSCLC) have been limited by small sample size and nonvalidated cardiac endpoints.OBJECTIVES The purpose of this analysis was to ascertain whether cardiac radiation dose is a predictor of major adverse cardiac events (MACE) and all-cause mortality (ACM).METHODS This retrospective analysis included 748 consecutive locally advanced NSCLC patients treated with thoracic radiotherapy. Fine and Gray and Cox regressions were used to identify predictors for MACE and ACM, adjusting for lung cancer and cardiovascular prognostic factors, including pre-existing coronary heart disease (CHD).RESULTS After amedian follow-up of 20.4 months, 77 patients developed >= 1 MACE (2-year cumulative incidence, 5.8%; 95% confidence interval [CI]: 4.3% to 7.7%), and 533 died. Mean radiation dose delivered to the heart (mean heart dose) was associated with a significantly increased risk of MACE (adjusted hazard ratio [HR]: 1.05/Gy; 95% CI: 1.02 to 1.08/Gy; p= 10 Gy vs.