- 學位論文
早期乳癌患者的重大心血管疾患風險
Risk of Major Adverse Cardiovascular Events in Early-Stage Breast Cancer Patients
摘要
研究目的：乳癌的治療方式中，化學治療，放射線治療以及內分泌治療都可能影響心臟健康。本研究透過國家資料庫研究台灣早期乳癌患者接受不同組合的輔助性治療後，其重大心血管疾患(major adverse cardiovascular events, MACE)的風險及其異同。 研究方法及資料：本研究串聯2007-2014年台灣全民健康保險資料庫、台灣癌症登記資料庫、以及內政部死亡原因檔，收集女性乳癌患者進行分析。在排除過去曾發生過有心臟疾患，以及曾用過Trazuzumab的患者後，根據其乳房手術後之輔助性治療進行分組，分組縮寫取其代表英文字母組成(內分泌治療H；化學治療C；放射治療R)。初步了解所有乳癌患者的分組狀態後，深入針對荷爾蒙陽性的患者透過inverse propensity score weighted-hazard ratio (IPTW-HR)，統計分析病患致死性及非致死性MACE的風險高低。 研究結果：共有26,874位病患納入分析，初步發現影響MACE的變數包括年齡、期別、輔助性治療分組，腫瘤大小以及其他共病等；左右側性並不影響後續MACE的風險。深入針對荷爾蒙陽性患者共19,007人，以H組為參考進行IPTW-HR運算，發現CRH組在非致死性MACE有明顯偏低的IPTW-HR 0.70 ( 95% 信賴區間 0.52–0.96)；但在致死性MACE四組之間沒有達到統計差異。若將不同MACE拆開比較，可發現CH組有較低的出血性中風風險；CRH組有較低的缺血性心臟病而RH組有較低的鬱血性心衰竭風險。對第二期患者來說，CRH及CH組跟H組相比可觀察到較低的MACE風險。 結論與建議：乳癌患者治療後的MACE有很多影響因素，例如年齡。在過去沒有心臟共病症的女性乳癌病人身上，合併一種以上的輔助性治療並不一定增加致死或非致死性的MACE風險。即使只使用荷爾蒙治療的病患，醫師仍應注意其後續的心臟健康。
並列摘要
Purpose: Breast cancer treatments, such as chemotherapy, radiotherapy and hormone therapy affects cardiac health to some degree. This nationwide population-based study investigated among patients with early-stage breast cancer in Taiwan the differences in the risks of major adverse cardiovascular events (MACE) after receiving different combinations of adjuvant treatments. Methods: Data regarding female breast cancer patients between 2007-2014 were collected from the National Health Insurance Research Database (NHIRD), Taiwan Cancer Registry Database (TCRD) and the national mortality data. After excluding patients who had cardiac morbidities prior to the study and those who had ever received Trazuzumab, the study populations were grouped according to their adjuvant treatments. The adjuvant treatment groups were presented by combing the initial of each treatment, namely H for hormone therapy; C for chemotherapy and R for radiotherapy. After preliminary analysis of all the patients, we further studied the risk of fatal and non-fatal MACE among hormone receptor–positive patients by using inverse propensity score weighted-hazard ratio (IPTW-HR). Results: Age, stage, adjuvant treatment, tumor size and comorbidities significantly affected the risks of MACE among the 26,874 patients analyzed. The laterality of the cancer didn’t affect the risk of MACE. Among 19,007 hormone receptor–positive patients, the IPTW-HR was significantly lower for non-fatal MACE in the CRH group compared to the H group (IPTW-HR 0.70, 95% confidence interval 0.52–0.96)。No statistical differences were seen in the risk of fatal MACE between the 4 groups. The CH group had a lower risk of hemorrhagic stroke while the CRH group had a lower risk of ischemic heart disease and the RH group had a lower risk of congestive heart failure. For stage II patients, the CRH and the CH groups had lower risks of MACE compared to the H group. Conclusion: Risk of MACE after breast cancer treatments is affected by many factors such as age. For patients who had no cardiac comorbidities, combing adjuvant modality to one another does not necessarily increase the risk of MACE. Cardiac toxicity from adjuvant treatments should be kept in mind even in patients receiving hormone therapy alone.
參考文獻
延伸閱讀
- 陳民虹（2005）。乳癌的流行病學特徵及危險因子。澄清醫護管理雜誌，1(1)，30-38。https://doi.org/10.30156/CCMJ.200501.0005
- 程雪敏（2011）。早期乳癌婦女憂鬱程度與生活品質相關因素探討-以中部某區域醫院為例〔碩士論文，中臺科技大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0099-1511201114152020
- 魏秀娟、陳得源、施宏俊、楊仁宏（2004）。遠心性環狀紅斑：一位合併乳癌的病例報告。中山醫學雜誌，15(2)，235-240。https://doi.org/10.30096/CSMJ.200412.0012
- Liao, S. F., Lee, Y. F., Chen, S. T., Kuo, S. J., Liang, W. C., Wei, T. S., & Liu, M. T. (2009). 乳癌後次發性淋巴水腫之發生率及危險因子分析. 台灣復健醫學雜誌, 37(4), 217-225. https://doi.org/10.6315/2009.37(4)01
- 李美雲、蕭正光、許淑蓮、張宏泰、徐南麗（2002）。A Study of Breast Cancer Patients' Uncertainty and Impact Factors。志為護理-慈濟護理雜誌，1(3)，57-65。https://doi.org/10.6974/TCNJ.200209.0057