胸部 CT 评估接受蒽环类药物和曲妥珠单抗辅助化疗的乳腺癌患者心外膜脂肪组织的变化

Yuyao Liu, Tingjian Zhang, Xiao Huang, Li Shen, Quan Yang
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Methods : We reviewed female BC patients who were treated with adjuvant chemotherapy protocols of AC-T and AC-TH, all of whom underwent baseline (T0) and follow-up (T1) chest computed tomography (CT) and echocardiography. A cohort of healthy women, matched in age, underwent two chest CTs. EAT was quantified on chest CT using semi-automated software. CTX was defined as a > 10% reduction in left ventricular ejection fraction (LVEF) from baseline, with an absolute value of < 53%. Results : A total of 41 BC patients were included in the study, with 23 patients in the AC-T group and 18 patients in the AC-TH group. Additionally, 22 healthy females were included as the normal group. None of the BC patients developed CTX after chemotherapy. The age did not differ significantly between the normal group and the AC-T group ( p = 0.341) or the AC-TH group ( p = 0.853). Similarly, the body mass index (BMI) of the normal group was comparable to that of the AC-T group ( p = 0.377, 0.346) and the AC-TH group ( p = 0.148, 0.119) before and after chemotherapy. The EAT volume index (mL/kg/m 2 ) was significantly higher in both the AC-T group (5.11 ± 1.85 vs. 4.34 ± 1.55, p < 0.001) and the AC-TH group (4.53 ± 1.61 vs. 3.48 ± 1.62, p < 0.001) at T1 compared with T0. In addition, both the AC-T group (–72.95 ± 5.01 vs. –71.22 ± 3.91, p = 0.005) and the AC-TH group (–72.55 ± 5.27 vs. –68.20 ± 5.98, p < 0.001) exhibited a significant decrease in EAT radiodensity (HU) at T1 compared to T0. However, there was no significant difference observed in the normal group. At T0, no difference was seen in EAT volume index (4.34 ± 1.55 vs. 3.48 ± 1.62, p = 0.090) and radiodensity (–71.22 ± 3.91 vs. –68.20 ± 5.98, p = 0.059) between the AC-T and AC-TH groups. 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引用次数: 0

摘要

背景:辅助化疗引起的心脏毒性(CTX)是影响乳腺癌(BC)患者预后和生活质量的一个重要因素。本研究旨在调查接受蒽环类药物辅助化疗方案(AC-T)和蒽环类药物联合曲妥珠单抗辅助化疗方案(AC-TH)的乳腺癌患者在治疗前后心外膜脂肪组织(EAT)的变化。此外,我们还评估了两组患者的 EAT 变化是否存在差异。我们的目的是研究蒽环类药物和曲妥珠单抗对 EAT 的影响,并确定 EAT 变化对 CTX 的潜在作用。方法:我们回顾了接受 AC-T 和 AC-TH 辅助化疗方案治疗的女性 BC 患者,她们都接受了基线(T0)和随访(T1)胸部计算机断层扫描(CT)和超声心动图检查。一组年龄相仿的健康女性接受了两次胸部 CT 检查。使用半自动软件对胸部 CT 上的 EAT 进行量化。CTX的定义是左心室射血分数(LVEF)比基线降低>10%,绝对值<53%。结果:共有 41 名 BC 患者参与研究,其中 AC-T 组 23 人,AC-TH 组 18 人。此外,还有 22 名健康女性作为正常组。没有一名 BC 患者在化疗后出现 CTX。正常组与 AC-T 组(P = 0.341)或 AC-TH 组(P = 0.853)的年龄差异不大。同样,化疗前后,正常组与 AC-T 组(P = 0.377,0.346)和 AC-TH 组(P = 0.148,0.119)的体重指数(BMI)相当。与T0相比,AC-T组(5.11 ± 1.85 vs. 4.34 ± 1.55,p < 0.001)和AC-TH组(4.53 ± 1.61 vs. 3.48 ± 1.62,p < 0.001)在T1时的EAT体积指数(mL/kg/m 2)均显著升高。此外,与T0相比,AC-T组(-72.95 ± 5.01 vs. -71.22 ± 3.91,p = 0.005)和AC-TH组(-72.55 ± 5.27 vs. -68.20 ± 5.98,p < 0.001)在T1时的EAT放射密度(HU)均有显著下降。然而,正常组没有观察到明显差异。在 T0 时,AC-T 组和 AC-TH 组的 EAT 容积指数(4.34 ± 1.55 vs. 3.48 ± 1.62,p = 0.090)和放射密度(-71.22 ± 3.91 vs. -68.20 ± 5.98,p = 0.059)无差异。同样,在T1,两组间的EAT体积指数(-5.11 ± 1.85 vs. 4.53 ± 1.61,p = 0.308)和放射密度(-72.95 ± 5.00 vs. -72.54 ± 5.27,p = 0.802)仍无显著差异。结论 :接受AC-T和AC-TH辅助化疗方案的BC患者在化疗后EAT体积指数显著上升,放射密度大幅下降。这些研究结果表明,EAT的变化可能有助于识别化疗药物引起的心脏并发症,并提醒临床医生关注BC患者辅助化疗后EAT的变化,以防止CTX的实际发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Changes in Epicardial Adipose Tissue Assessed by Chest CT in Breast Cancer Patients Receiving Adjuvant Chemotherapy with Anthracyclines and Trastuzumab
Background : Cardiotoxicity (CTX) induced by adjuvant chemotherapy is a significant factor that impacts the prognosis and quality of life in breast cancer (BC) patients. In this study, we aimed to investigate the changes in epicardial adipose tissue (EAT) before and after treatment in BC patients who received anthracyclines adjuvant chemotherapy protocol (AC-T) and anthracyclines combined with trastuzumabadjuvant chemotherapy protocol (AC-TH). Additionally, we assessed whether there were any differences in the changes in EAT between the two groups of patients. Our objective was to examine the effects of anthracyclines and trastuzumab on EAT and determine the potential role of EAT changes on CTX. Methods : We reviewed female BC patients who were treated with adjuvant chemotherapy protocols of AC-T and AC-TH, all of whom underwent baseline (T0) and follow-up (T1) chest computed tomography (CT) and echocardiography. A cohort of healthy women, matched in age, underwent two chest CTs. EAT was quantified on chest CT using semi-automated software. CTX was defined as a > 10% reduction in left ventricular ejection fraction (LVEF) from baseline, with an absolute value of < 53%. Results : A total of 41 BC patients were included in the study, with 23 patients in the AC-T group and 18 patients in the AC-TH group. Additionally, 22 healthy females were included as the normal group. None of the BC patients developed CTX after chemotherapy. The age did not differ significantly between the normal group and the AC-T group ( p = 0.341) or the AC-TH group ( p = 0.853). Similarly, the body mass index (BMI) of the normal group was comparable to that of the AC-T group ( p = 0.377, 0.346) and the AC-TH group ( p = 0.148, 0.119) before and after chemotherapy. The EAT volume index (mL/kg/m 2 ) was significantly higher in both the AC-T group (5.11 ± 1.85 vs. 4.34 ± 1.55, p < 0.001) and the AC-TH group (4.53 ± 1.61 vs. 3.48 ± 1.62, p < 0.001) at T1 compared with T0. In addition, both the AC-T group (–72.95 ± 5.01 vs. –71.22 ± 3.91, p = 0.005) and the AC-TH group (–72.55 ± 5.27 vs. –68.20 ± 5.98, p < 0.001) exhibited a significant decrease in EAT radiodensity (HU) at T1 compared to T0. However, there was no significant difference observed in the normal group. At T0, no difference was seen in EAT volume index (4.34 ± 1.55 vs. 3.48 ± 1.62, p = 0.090) and radiodensity (–71.22 ± 3.91 vs. –68.20 ± 5.98, p = 0.059) between the AC-T and AC-TH groups. Similarly, at T1, there was still no significant difference observed in the EAT volume index (–5.11 ± 1.85 vs. 4.53 ± 1.61, p = 0.308) and radiodensity (–72.95 ± 5.00 vs. –72.54 ± 5.27, p = 0.802) between the two groups. Conclusions : BC patients who underwent AC-T and AC-TH adjuvant chemotherapy protocols demonstrated a significant rise in the volume index of EAT, along with a substantial reduction in its radiodensity post-chemotherapy. These findings indicate that alterations in EAT could potentially aid in identifying cardiac complications caused by chemotherapeutic agents and remind clinicians to focus on changes in EAT after adjuvant chemotherapy in BC patients to prevent the practical occurrence of CTX.
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