Objective: To evaluate the anthracyclines-induced cardiotoxicity in patients with early-stage breast cancer. Methods: This retrospective study analyzed data of 64 patients (aged from 36 to 59 years old) with early-stage breast cancer after surgery. Patients were divided into ACT group (n=21), FAC group (n=19) and EC group (n=24). The NCI CTC 4.0 scores was used to evaluate the side effects at the time of 2 weeks, 4 weeks and 6 weeks after chemotherapy. Meanwhile, the level of cTnT, the incidence of abnormal electrocardiogram (ECG) and left ventricular ejection fraction (LVEF) were used to evaluate the anthracyclines-induced cardiotoxicity, the follow-up observation points were as follows: at the acute cardiotoxicity (time A), subacute cardiotoxicity (time B), 24 months after chemotherapy (time C), 36 months after chemotherapy (time D), 48 months after chemotherapy (time E), 60 months after chemotherapy (time F). The 3-years and 5-years overall survival and progress free disease survival among three groups were compared. Results: The ages, clinical stage, the size of tumor, axillary lymph node positivity and Eastern Cooperative Oncology Group Scores were similar among three groups (P>0.05); the incidence of side effects level 4 was 0. The levels of cTnT in the three groups were significantly lower than those at the baseline and time points C, D, E and F (all P<0.05), and the levels of cTnT were significantly higher in EC group than in FAC and ACT group at the time points B, C, D, E and F (P<0.05); however, the incidence of abnormal ECG and LVEF was similar among the 3 groups (P>0.05). The 5-year overall survival was 95.2% (20/21) ,100% (19/19) and 95.8% (23/24) in ACT group, FAC group and EC group, respectively; 5-year progress free disease survival was 95.2% (20/21) ,94.7% (18/19) and 91.7% (22/24) in ACT group, FAC group and EC group, respectively (P>0.05) . Conclusions: Patients with early-stage breast cancer after surgery could tolerate the anthracyclines-induced cardiotoxicity. Three chemotherapy schemes of ACT, FAC and EC, especially the EC protocol, could affect the myocardial damage. However, outcome is comparable among patients treated with above chemotherapy schemes in this patient cohort.
目的： 观察蒽环类药物对早期乳腺癌术后患者心脏毒性的影响。 方法： 回顾性分析2009年1月至2014年1月于河南省人民医院就诊，经病理确诊且符合纳入标准的早期乳腺癌患者64例，年龄36~59岁。其中ACT组（多柔比星+环磷酰胺，序贯多西他赛）21例、FAC组（5-氟尿嘧啶+多柔比星+环磷酰胺）19例、EC组（表柔比星+环磷酰胺）24例。分别在化疗2、4和6周期后，采用美国癌症中心通用不良事件术语标准4.0版量表评价各组的化疗不良反应，分为0~4级；同时观察各组的心肌肌钙蛋白T（cTnT）水平、12导联心电图和左心射血分数，观察点分别为急性毒性反应时间（时间点A）、亚急性毒性反应时间（时间点B）、化疗结束后24个月（时间点C）、化疗结束后36个月（时间点D）、化疗结束后48个月（时间点E）和化疗结束后60个月（时间点F）；并比较各组患者5年总生存率和无病生存率的差别。 结果： 3组患者在年龄、分期、乳腺肿块大小、腋窝淋巴结阳性、ECOG评分等方面差异均无统计学意义（P>0.05）；全组均未发生4级化疗毒性反应。3组的cTnT水平在基线及时间点C、D、E和F均明显低于时间点A，且差异均有统计学意义（P均<0.05）；EC组的cTnT指标在化疗2周后的各随访时间点均高于FAC组合ACT组，且差异有统计学意义（P均<0.05）。3组心电图异常率和左心射血分数水平在各随访时间点间的差异均无统计学意义（P>0.05）。ACT组、FAC组和EC组的5年总生存率分别为95.2%（20/21）、100%（19/19）和95.8%（23/24），5年无病生存率分别为95.2%（20/21）、94.7%（18/19）和91.7%（22/24），各组的总生存率和无病生存率差异无统计学意义（P均>0.05）。 结论： 早期乳腺癌术后患者均可耐受蒽环类药物为主的化疗方案，ACT、FAC和EC方案均可引起心肌损伤，EC方案诱发的心脏晚期毒性反应高于其他化疗方案，但对患者的预后无影响。.
Keywords: Anthracyclines; Breast neoplasms; Cardiotoxicity.