Tzu-Yu Lai , Yu-Wen Hu , Ti-Hao Wang , Jui-Pin Chen , Cheng-Ying Shiau , Pin-I Huang , I-Chun Lai , Yu-Ming Liu , Chi-Cheng Huang , Ling-Ming Tseng , Nicole Huang , Chia-Jen Liu
{"title":"使用改进的广义莱曼正常组织并发症概率模型估算左侧乳腺癌放疗后发生重大心脏不良事件的风险","authors":"Tzu-Yu Lai , Yu-Wen Hu , Ti-Hao Wang , Jui-Pin Chen , Cheng-Ying Shiau , Pin-I Huang , I-Chun Lai , Yu-Ming Liu , Chi-Cheng Huang , Ling-Ming Tseng , Nicole Huang , Chia-Jen Liu","doi":"10.1016/j.breast.2024.103788","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>We introduced an adapted Lyman normal-tissue complication probability (NTCP) model, incorporating clinical risk factors and censored time-to-event data, to estimate the risk of major adverse cardiac events (MACE) following left breast cancer radiotherapy (RT).</p></div><div><h3>Materials and methods</h3><p>Clinical characteristics and MACE data of 1100 women with left-side breast cancer receiving postoperative RT from 2005 to 2017 were retrospectively collected. A modified generalized Lyman NTCP model based on the individual left ventricle (LV) equivalent uniform dose (EUD), accounting for clinical risk factors and censored data, was developed using maximum likelihood estimation. Subgroup analysis was performed for low-comorbidity and high-comorbidity groups.</p></div><div><h3>Results</h3><p>Over a median follow-up 7.8 years, 64 patients experienced MACE, with higher mean LV dose in affected individuals (4.1 Gy vs. 2.9 Gy). The full model accounting for clinical factors identified <em>D</em><sub><em>50</em></sub> = 43.3 Gy, <em>m</em> = 0.59, and <em>n</em> = 0.78 as the best-fit parameters. The threshold dose causing a 50 % probability of MACE was lower in the high-comorbidity group (<em>D</em><sub><em>50</em></sub> = 30 Gy) compared to the low-comorbidity group (<em>D</em><sub><em>50</em></sub> = 45 Gy). Predictions indicated that restricting LV EUD below 5 Gy yielded a 10-year relative MACE risk less than 1.3 and 1.5 for high-comorbidity and low-comorbidity groups, respectively.</p></div><div><h3>Conclusion</h3><p>Patients with comorbidities are more susceptible to cardiac events following breast RT. The proposed modified generalized Lyman model considers nondosimetric risk factors and addresses incomplete follow-up for late complications, offering comprehensive and individualized MACE risk estimates post-RT.</p></div>","PeriodicalId":9093,"journal":{"name":"Breast","volume":"77 ","pages":"Article 103788"},"PeriodicalIF":5.7000,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S096097762400119X/pdfft?md5=e1cfaf65c5238f23c38f51e2f3bbe5a6&pid=1-s2.0-S096097762400119X-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Estimating the risk of major adverse cardiac events following radiotherapy for left breast cancer using a modified generalized Lyman normal-tissue complication probability model\",\"authors\":\"Tzu-Yu Lai , Yu-Wen Hu , Ti-Hao Wang , Jui-Pin Chen , Cheng-Ying Shiau , Pin-I Huang , I-Chun Lai , Yu-Ming Liu , Chi-Cheng Huang , Ling-Ming Tseng , Nicole Huang , Chia-Jen Liu\",\"doi\":\"10.1016/j.breast.2024.103788\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>We introduced an adapted Lyman normal-tissue complication probability (NTCP) model, incorporating clinical risk factors and censored time-to-event data, to estimate the risk of major adverse cardiac events (MACE) following left breast cancer radiotherapy (RT).</p></div><div><h3>Materials and methods</h3><p>Clinical characteristics and MACE data of 1100 women with left-side breast cancer receiving postoperative RT from 2005 to 2017 were retrospectively collected. A modified generalized Lyman NTCP model based on the individual left ventricle (LV) equivalent uniform dose (EUD), accounting for clinical risk factors and censored data, was developed using maximum likelihood estimation. Subgroup analysis was performed for low-comorbidity and high-comorbidity groups.</p></div><div><h3>Results</h3><p>Over a median follow-up 7.8 years, 64 patients experienced MACE, with higher mean LV dose in affected individuals (4.1 Gy vs. 2.9 Gy). The full model accounting for clinical factors identified <em>D</em><sub><em>50</em></sub> = 43.3 Gy, <em>m</em> = 0.59, and <em>n</em> = 0.78 as the best-fit parameters. The threshold dose causing a 50 % probability of MACE was lower in the high-comorbidity group (<em>D</em><sub><em>50</em></sub> = 30 Gy) compared to the low-comorbidity group (<em>D</em><sub><em>50</em></sub> = 45 Gy). Predictions indicated that restricting LV EUD below 5 Gy yielded a 10-year relative MACE risk less than 1.3 and 1.5 for high-comorbidity and low-comorbidity groups, respectively.</p></div><div><h3>Conclusion</h3><p>Patients with comorbidities are more susceptible to cardiac events following breast RT. The proposed modified generalized Lyman model considers nondosimetric risk factors and addresses incomplete follow-up for late complications, offering comprehensive and individualized MACE risk estimates post-RT.</p></div>\",\"PeriodicalId\":9093,\"journal\":{\"name\":\"Breast\",\"volume\":\"77 \",\"pages\":\"Article 103788\"},\"PeriodicalIF\":5.7000,\"publicationDate\":\"2024-08-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S096097762400119X/pdfft?md5=e1cfaf65c5238f23c38f51e2f3bbe5a6&pid=1-s2.0-S096097762400119X-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Breast\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S096097762400119X\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Breast","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S096097762400119X","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Estimating the risk of major adverse cardiac events following radiotherapy for left breast cancer using a modified generalized Lyman normal-tissue complication probability model
Background
We introduced an adapted Lyman normal-tissue complication probability (NTCP) model, incorporating clinical risk factors and censored time-to-event data, to estimate the risk of major adverse cardiac events (MACE) following left breast cancer radiotherapy (RT).
Materials and methods
Clinical characteristics and MACE data of 1100 women with left-side breast cancer receiving postoperative RT from 2005 to 2017 were retrospectively collected. A modified generalized Lyman NTCP model based on the individual left ventricle (LV) equivalent uniform dose (EUD), accounting for clinical risk factors and censored data, was developed using maximum likelihood estimation. Subgroup analysis was performed for low-comorbidity and high-comorbidity groups.
Results
Over a median follow-up 7.8 years, 64 patients experienced MACE, with higher mean LV dose in affected individuals (4.1 Gy vs. 2.9 Gy). The full model accounting for clinical factors identified D50 = 43.3 Gy, m = 0.59, and n = 0.78 as the best-fit parameters. The threshold dose causing a 50 % probability of MACE was lower in the high-comorbidity group (D50 = 30 Gy) compared to the low-comorbidity group (D50 = 45 Gy). Predictions indicated that restricting LV EUD below 5 Gy yielded a 10-year relative MACE risk less than 1.3 and 1.5 for high-comorbidity and low-comorbidity groups, respectively.
Conclusion
Patients with comorbidities are more susceptible to cardiac events following breast RT. The proposed modified generalized Lyman model considers nondosimetric risk factors and addresses incomplete follow-up for late complications, offering comprehensive and individualized MACE risk estimates post-RT.
期刊介绍:
The Breast is an international, multidisciplinary journal for researchers and clinicians, which focuses on translational and clinical research for the advancement of breast cancer prevention, diagnosis and treatment of all stages.