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<p>Anthracyclines are widely used in breast cancer and hematologic malignancies but are associated with cancer therapy-related cardiac dysfunction (CTRCD). This study aimed to evaluate the clinical utility of the Heart Failure Association–International Cardio-Oncology Society (HFA–ICOS) risk tool for baseline risk stratification. We conducted a retrospective, single-center cohort study of consecutive patients aged 16 years or older with breast cancer or hematologic malignancies who received anthracycline-based chemotherapy for the first time between January 2016 and December 2024. Baseline cardiovascular risk was stratified according to the HFA–ICOS criteria, and CTRCD was defined based on the 2022 European Society of Cardiology guidelines. Among 591 patients included in the final analytic cohort, 40 (6.8%) developed CTRCD during a median observation period of 3.7 years (interquartile range [IQR] 1.6–5.9). Incidence increased stepwise across HFA–ICOS categories (low 4.4%, moderate 8.2%, high/very high 22.9%; <i>p</i> &lt; 0.001). Symptomatic CTRCD was more frequent in the high/very high-risk category (17.1%) compared with the moderate (4.1%) and low (1.7%) categories (<i>p</i> &lt; 0.001). Independent predictors were age (per year; odds ratio [OR] 0.94; 95% confidence interval [CI], 0.91–0.97; <i>p</i> &lt; 0.001), body mass index (per kg/m<sup>2</sup>; OR 0.86; 95% CI 0.79–0.95; <i>p</i> = 0.002), diabetes mellitus (OR 2.91; 95% CI 1.11–7.60; <i>p</i> = 0.030), hematologic malignancies (vs. breast cancer) (OR 3.63; 95% CI 1.32–9.73; <i>p</i> = 0.013), and cumulative doxorubicin-equivalent doses ≥ 400&#xa0;mg/m<sup>2</sup> (OR 4.47; 95% CI 1.67–11.9; <i>p</i> = 0.003). The low-risk category was independently associated with a significantly reduced risk of CTRCD (OR 0.23; 95% CI 0.09–0.59; <i>p</i> = 0.002), whereas the high/very high-risk category was independently associated with a markedly increased risk (OR 4.32; 95% CI 1.33–14.0; <i>p</i> = 0.015). Overall survival differed significantly between patients with and without CTRCD (log-rank <i>p</i> = 0.025). In this retrospective heterogeneous tumor cohort, CTRCD incidence and severity increased across HFA–ICOS risk categories, highlighting the tool’s utility for risk stratification and the importance of cardio-oncology collaboration to mitigate cardiotoxicity while preserving oncologic efficacy.</p>

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Risk of cardiac dysfunction in patients receiving anthracyclines across breast cancer and hematologic malignancies: a single-center retrospective cohort study in Japan

  • 期刊论文

  • 发表日期：

    2026年2月1日

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  • Yujiro Homma,
  • Kazuyoshi Kimura,
  • Kenta Sasaki,
  • Yuji Okura,
  • Takeshi Kashimura,
  • Takayuki Inomata,
  • Yasuo Saijo,
  • Qiliang Zhou

摘要

Anthracyclines are widely used in breast cancer and hematologic malignancies but are associated with cancer therapy-related cardiac dysfunction (CTRCD). This study aimed to evaluate the clinical utility of the Heart Failure Association–International Cardio-Oncology Society (HFA–ICOS) risk tool for baseline risk stratification. We conducted a retrospective, single-center cohort study of consecutive patients aged 16 years or older with breast cancer or hematologic malignancies who received anthracycline-based chemotherapy for the first time between January 2016 and December 2024. Baseline cardiovascular risk was stratified according to the HFA–ICOS criteria, and CTRCD was defined based on the 2022 European Society of Cardiology guidelines. Among 591 patients included in the final analytic cohort, 40 (6.8%) developed CTRCD during a median observation period of 3.7 years (interquartile range [IQR] 1.6–5.9). Incidence increased stepwise across HFA–ICOS categories (low 4.4%, moderate 8.2%, high/very high 22.9%; p < 0.001). Symptomatic CTRCD was more frequent in the high/very high-risk category (17.1%) compared with the moderate (4.1%) and low (1.7%) categories (p < 0.001). Independent predictors were age (per year; odds ratio [OR] 0.94; 95% confidence interval [CI], 0.91–0.97; p < 0.001), body mass index (per kg/m2; OR 0.86; 95% CI 0.79–0.95; p = 0.002), diabetes mellitus (OR 2.91; 95% CI 1.11–7.60; p = 0.030), hematologic malignancies (vs. breast cancer) (OR 3.63; 95% CI 1.32–9.73; p = 0.013), and cumulative doxorubicin-equivalent doses ≥ 400 mg/m2 (OR 4.47; 95% CI 1.67–11.9; p = 0.003). The low-risk category was independently associated with a significantly reduced risk of CTRCD (OR 0.23; 95% CI 0.09–0.59; p = 0.002), whereas the high/very high-risk category was independently associated with a markedly increased risk (OR 4.32; 95% CI 1.33–14.0; p = 0.015). Overall survival differed significantly between patients with and without CTRCD (log-rank p = 0.025). In this retrospective heterogeneous tumor cohort, CTRCD incidence and severity increased across HFA–ICOS risk categories, highlighting the tool’s utility for risk stratification and the importance of cardio-oncology collaboration to mitigate cardiotoxicity while preserving oncologic efficacy.