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中国癌症防治杂志

中国癌症防治杂志 ›› 2025, Vol. 17 ›› Issue (5): 555-561.doi: 10.3969/j.issn.1674-5671.2025.05.05

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曲妥珠单抗致乳腺癌患者心血管毒性的临床特征及危险因素分析

  

  1. 大连医科大学附属第一医院肿瘤科；大连医科大学附属第一医院心内科
  • 出版日期:2025-10-25 发布日期:2025-12-03
  • 通讯作者: 方凤奇 E-mail：18098876723@163.com
  • 基金资助:
    癌症、心脑血管、呼吸和代谢性疾病防治研究国家科技重大专项项目（2023ZD0502700；2023ZD0502704）

Clinical features and risk factors of Trastuzumab-induced cardiotoxicity in breast cancer

  • Online:2025-10-25 Published:2025-12-03

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摘要： 目的 探讨乳腺癌患者应用曲妥珠单抗治疗致心血管毒性的发生情况及影响因素，并探索欧洲心脏病学会心力衰竭协会（Heart Failure Association, HFA）⁃国际心脏肿瘤学会（International Cardio⁃Oncology Society, ICOS）评分风险分层的评估效能。方法 纳入2012年6月至2024年6月在大连医科大学附属第一医院接受曲妥珠单抗治疗的人表皮生长因子受体2（human epidermal growth factor receptor 2，HER2）阳性乳腺癌患者298例。采用2022版欧洲心脏病学会指南推荐的HFA⁃ICOS评分进行肿瘤治疗相关心血管毒性（cancer therapy⁃related cardiovascular toxicity,CTR⁃CVT）的基线风险评估，将患者分为低、中、高和极高风险组。通过单因素分析及多因素 Logistic 回归模型分析患者发生心血管毒性的危险因素。结果 298例患者中曲妥珠单抗治疗相关心血管毒性发生率为7.4%（22/298），包括心律失常（68.2%,15/22）、肿瘤治疗相关心功能不全（27.3%,6/22）和血管毒性（4.5%,1/22）。Ki⁃67≥30%、方案中含蒽环类药物、合并冠心病及有吸烟史是曲妥珠单抗致HER2阳性乳腺癌患者心血管毒性的独立危险因素（均P<0.05）。HFA⁃ICOS评分的结果显示，高危患者的CTR⁃CVT发生率（25.0%）高于低危（5.6%）和中危（9.6%）患者。结论 曲妥珠单抗致HER2阳性乳腺癌患者的心血管毒性主要表现为心律失常，其相关心血管毒性危险因素包括应用蒽环类药物、有吸烟史、合并冠心病以及Ki⁃67≥30%，临床中可借助HFA⁃ICOS评分对患者进行风险分层以实施差异化的监测。

关键词: HER2阳性乳腺癌, 曲妥珠单抗, 心血管毒性, HFA?ICOS评分

Abstract: Objective To retrospectively analyze the incidence and influencing factors of Trastuzumab⁃induced cardiovascular toxicity among breast cancer patients and to explore the risk stratification efficacy of the Heart Failure Association (HFA) of the European Society of Cardiology⁃International Cardio⁃Oncology Society (ICOS) score. Methods This analysis included 298 patients with human epidermal growth factor receptor 2 (HER2)⁃positive breast cancer who received Trastuzumab treatment at the First Affiliated Hospital of Dalian Medical University between June 2012 and June 2024. Baseline risk assessment for cancer therapy⁃related cardiovascular toxicity (CTR⁃CVT) was performed using the HFA⁃ICOS score recommended by the 2022 European Society of Cardiology guidelines, categorizing patients into low⁃, intermediate⁃, high⁃, and very⁃high⁃risk groups. Univariable analysis and multivariable Logistic regression  model were used to identify risk factors for cardiovascular toxicity. Results Among the 298 patients, the incidence of Trastuzumab⁃related cardiovascular toxicity was 7.4% (22/298), including arrhythmias (68.2%, 15/22), cancer therapeutics⁃related cardiac dysfunction (27.3%, 6/22), and vascular toxicity (4.5%, 1/22). Independent risk factors for cardiovascular toxicity in HER2⁃positive breast cancer patients treated with Trastuzumab were identified as Ki⁃67 ≥30%, anthracycline⁃containing regimens, and smoking history (all P<0.05). The HFA⁃ICOS score indicated that the incidence of CTR⁃CVT in high⁃risk patients (25.0%) was higher than in low⁃risk (5.6%) and medium⁃risk (9.6%) patients. Conclusions Trastuzumab⁃related cardiovascular toxicity primarily manifests as arrhythmias, with associated risk factors including anthracycline use, smoking history, comorbid coronary heart disease, and Ki⁃67≥30%. Clinically, the HFA⁃ICOS score can be utilized for risk stratification to implement differentiated monitoring.

Key words: HER2?positive breast cancer, Trastuzumab, Cardiovascular toxicity, HFA?ICOS score

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