Background:5-Fluorouracil(5-FU)and capecitabine-associated cardiotoxicity ranging from asymptomatic electro-cardiography(ECG)abnormalities to severe myocardial infarction has been reported in a number of studies,but s...Background:5-Fluorouracil(5-FU)and capecitabine-associated cardiotoxicity ranging from asymptomatic electro-cardiography(ECG)abnormalities to severe myocardial infarction has been reported in a number of studies,but such cardiotoxicity in Chinese patients with malignant diseases has not been investigated to date.In the present study,we aimed to prospectively evaluate the incidence rates and clinical manifestations of 5-FU-and capecitabine-associated cardiotoxicity in cancer patients recruited from multiple centers in China.Methods:Among the 527 patients who completed the study,196 received 5-FU-based chemotherapy and 331 received capecitabine-based chemotherapy as either first-line or adjuvant therapy.Adverse events were reported during the treatment and up to 28 days of follow-up.Outcome measures included ECG,myocardial enzymes,cardiac troponin,brain natriuretic peptide and echocardiography.Univariate analysis and logistic regression were performed for subgroup analysis and identification of significant independent variables that are associated with cardiotoxicity of both agents.Results:In total,161 of 527 patients(30.6%)experienced cardiotoxicity.The incidence rate of cardiotoxicity was 33.8%(112/331)in the capecitabine group,which was significantly higher than the rate of 25%(49/196)in the 5-FU group(P=0.0042).110/527 patients(20.9%)suffered arrhythmia,105/527(19.9%)developed ischemic changes,while only 20/527 patients(3.8%)presented heart failure and 6/527 patients(1.1%)had myocardial infarction.Pre-existing cardiac disease,hypertension,capecitabine-based chemotherapy and duration of treatment were identified as sig-nificant risk factors associated with cardiotoxicity.The odds ratio were 15.7(prior history of cardiac disease versus no history),1.86(capecitabine versus 5-FU),1.06(5-8 versus 1-4 chemotherapy cycles)and 1.58(hypertension versus no hypertension),respectively.Conclusions:Cardiotoxicity induced by fluoropyrimidines in the Chinese population may be underestimated in clini-cal practice.Close monitori展开更多
目的系统评价胸部肿瘤放疗后心脏毒性的发生率,为临床工作中放射性心脏损伤(RIHD)的评估和预防提供循证医学依据。方法检索PubMed、Web of Science、Embase、Cochrane图书馆、中国知网、万方数据库,检索起止时间为2007年1月至2018年1月...目的系统评价胸部肿瘤放疗后心脏毒性的发生率,为临床工作中放射性心脏损伤(RIHD)的评估和预防提供循证医学依据。方法检索PubMed、Web of Science、Embase、Cochrane图书馆、中国知网、万方数据库,检索起止时间为2007年1月至2018年1月,并查询所有纳入文献的参考文献。两名研究者根据纳入与排除标准筛选文献,采用美国医疗保健研究与质量机构(AHRQ)量表评估文献质量,使用Stata 12.0软件进行Meta分析。结果 24篇文献纳入Meta分析,共1 870例胸部肿瘤患者,RIHD的总发生率为42%(95%CI:0.32～0.52);其中心电图异常率为37%,心肌酶异常率为20%,肌钙蛋白异常率为12%。不同肿瘤类型分层研究,RIHD发生率不同:乳腺癌患者为15%,食管癌为29%,肺癌为39%。不同评价标准分层分析:以放射治疗肿瘤组(RTOG)标准评价,RIHD发生率为15%;而以美国国立癌症研究所常见毒性事件标准(NCI-CTCAE)评价,RIHD发生率为59%。结论胸部肿瘤患者RIHD总发生率高达42%,临床观察指标中以心电图异常最为常见;不同部位肿瘤RIHD发生率有较大差异,肺癌RIHD发生率最高,食管癌次之,乳腺癌最低;以CTCAE标准评价,RIHD发生率明显高于RTOG标准。展开更多
文摘Background:5-Fluorouracil(5-FU)and capecitabine-associated cardiotoxicity ranging from asymptomatic electro-cardiography(ECG)abnormalities to severe myocardial infarction has been reported in a number of studies,but such cardiotoxicity in Chinese patients with malignant diseases has not been investigated to date.In the present study,we aimed to prospectively evaluate the incidence rates and clinical manifestations of 5-FU-and capecitabine-associated cardiotoxicity in cancer patients recruited from multiple centers in China.Methods:Among the 527 patients who completed the study,196 received 5-FU-based chemotherapy and 331 received capecitabine-based chemotherapy as either first-line or adjuvant therapy.Adverse events were reported during the treatment and up to 28 days of follow-up.Outcome measures included ECG,myocardial enzymes,cardiac troponin,brain natriuretic peptide and echocardiography.Univariate analysis and logistic regression were performed for subgroup analysis and identification of significant independent variables that are associated with cardiotoxicity of both agents.Results:In total,161 of 527 patients(30.6%)experienced cardiotoxicity.The incidence rate of cardiotoxicity was 33.8%(112/331)in the capecitabine group,which was significantly higher than the rate of 25%(49/196)in the 5-FU group(P=0.0042).110/527 patients(20.9%)suffered arrhythmia,105/527(19.9%)developed ischemic changes,while only 20/527 patients(3.8%)presented heart failure and 6/527 patients(1.1%)had myocardial infarction.Pre-existing cardiac disease,hypertension,capecitabine-based chemotherapy and duration of treatment were identified as sig-nificant risk factors associated with cardiotoxicity.The odds ratio were 15.7(prior history of cardiac disease versus no history),1.86(capecitabine versus 5-FU),1.06(5-8 versus 1-4 chemotherapy cycles)and 1.58(hypertension versus no hypertension),respectively.Conclusions:Cardiotoxicity induced by fluoropyrimidines in the Chinese population may be underestimated in clini-cal practice.Close monitori
