乳腺癌治疗相关心血管毒性风险的临床评分体系构建及效能评估  

Construction and efficacy evaluation of clinical scoring system for breast cancer treatment-related cardiotoxicity

作　　者：朱梓嫣 陈佳慧 张玲云 黄宇峰 朱玮 程蕾蕾 Zhu Ziyan;Chen Jiahui;Zhang Lingyun;Huang Yufeng;Zhu Wei;Cheng Leilei(Research Department,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai Institute of Cardiovascular Diseases,Shanghai 200032,China;Propaganda Department,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Comprehensive Office of Shanghai Geriatrics Center,Shanghai 200032,China;Department of General Surgery,Thyroid and Breast Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Cardiac Ultrasound Diagnosis,Zhongshan Hospital,Fudan University,Shanghai Institute of Cardiovascular Diseases,Shanghai Institute of Imaging Medicine,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院科研处,上海200032 [2]复旦大学附属中山医院宣传部,上海200032 [3]复旦大学附属中山医院普外科甲状腺、乳腺外科,上海200032 [4]复旦大学附属中山医院心内科,上海市心血管病研究所,200032 [5]上海市老年医学中心综合办公室,200032 [6]复旦大学附属中山医院心脏超声诊断科,上海市心血管病研究所,上海市影像医学研究所,200032

出　　处：《中国心血管杂志》2024年第2期99-105,共7页Chinese Journal of Cardiovascular Medicine

基　　金：国家自然科学基金(82170359);上海申康医院发展中心市级医院诊疗技术推广及优化管理技术规范化管理和推广项目(SHDC22023207);中山医院临床研究专项基金(2020ZSLC21)。

摘　　要：目的运用《乳腺癌治疗相关心血管毒性临床评分表》对乳腺癌入院患者进行心血管疾病危重程度的评估,比较评分表对心脏毒性的判断结果与医生诊断的一致性,从而评估该评分表对心脏毒性的筛查效果,以协助乳腺癌患者心血管疾病的早发现和早治疗。方法单中心回顾性研究。纳入2016年1月至2019年12月在复旦大学附属中山医院普外科行乳腺癌手术治疗的患者,记录其年龄、放疗史等一般临床资料,使用本项目课题组拟定的《乳腺癌治疗相关心血管毒性临床评分表》对患者进行术前心血管疾病危重程度和是否耐受术后放、化疗的评估,将年龄、既往史、心电图异常、超声心动图异常、蒽环类治疗史等不同危险因素按影响程度赋值并求和,结果评分<9分视作低危人群,≥9分且<15分为中危人群,≥15分即为高危人群。将评分表的评估结果与心内科医生的临床诊断进行比较,分析评分表的有效性。结果共行乳腺癌手术1989例,其中921例完成评分表与临床评估,女性916例,男性5例。根据评分表评定为低危人群的有861例,中危人群37例,高危人群23例。心内科医生评定为低危人群的有866例,中危人群43例,高危人群12例。统计结果显示,该评分表的中高危检测敏感度为94.55%(95%CI:84.88%~98.86%),特异度99.08%(95%CI:98.19%~99.60%),阳性预测率86.67%(95%CI:76.48%~92.85%),阴性预测率99.65%(95%CI:98.96%~99.88%),整体准确率为98.81%(95%CI:97.87%~99.40%)。该评分表整体准确率高,尤其是针对高危人群的鉴别效果明显(高危C评级敏感度100.00%,95%CI:85.18%~100.00%)。但相对而言,其对低危与中危边缘值界定标准模糊,导致中危B评级的敏感度为90.62%(95%CI:74.98%~98.02%)。在加入冠状动脉中度狭窄与频发期前收缩两项较高赋值项(9分)后,中危B评级与高危C评级间特异度下降为77.08%(95%CI:62.69%~87.97%)。结论《乳腺癌治疗相关心血管毒性Objective To construct and evaluate the efficacy of clinical scoring system for breast cancer treatment-related cardiotoxicity.Methods This study was a single-center retrospective study.From January 2016 to December 2019,the general clinical data of patients who underwent breast cancer surgery in Zhongshan Hospital Affiliated to Fudan University were recorded,and the severity of cardiovascular disease before operation and whether they could tolerate postoperative radiotherapy and chemotherapy were evaluated by using the clinical scoring system for breast cancer treatment-related cardiotoxicity prepared by the research team of this project.The different risk factors such as age,past medical history,abnormal ECG,abnormal heart and anthracycline treatment history were assigned and summed up according to the influence degree.Points<9 were classified as low-risk group;Points≥9 and<15 were classified as medium-risk group;Points≥15 were classified as high-risk group.The evaluation results were compared with the clinical diagnosis of cardiologists.Results A total of 1989 patients were included,of which 921 cases completed the Scoring Form and clinical evaluation,including 916 females and 5 males.There were 861 patients in the low-risk group,37 in the middle-risk group and 23 in the high-risk group.There were 866 low-risk,43 middle-risk and 12 high-risk assessed by cardiologists.The statistical results showed that the sensitivity,specificity and positive predictive rate of this clinical scoring system were 94.55%(95%CI:84.88%-98.86%),99.08%(95%CI:98.19%-99.60%)and 86.67%(95%CI:76.48%-92.85%),respectively.The overall accuracy of the scoring table was high,especially for high-risk group(the sensitivity of high-risk C rating was 100.00%,95%CI:85.18%-100.00%).However,relatively,the definition criteria of low-risk and medium-risk marginal values were vague,which led to the sensitivity of medium-risk B rating of 90.62%(95%CI:74.98%-98.02%).After adding two high-rated items(9 points)of moderate coronary artery stenosis and f

关 键 词：乳腺癌 心脏毒性 术前评估 评分表 

分 类 号：R73[医药卫生—肿瘤]