Kardiopulmonální funkce a její pokles v celém průběhu přežívání pacientek s karcinomem prsu

SOUHRN

Cíl

Posoudit kardiopulmonální funkci (měřenou pomocí vrcholové spotřeby kyslíku [VO2peak]) v celém průběhu přežívání po stanovení diagnózy karcinomu prsu a její prognostický význam u žen s metastatickým onemocněním.

Pacientky a metody

Byly hodnoceny pacientky s karcinomem prsu reprezentující čtyři průřezové kohorty, tj. kohortu (1) před adjuvantní terapií, (2) v průběhu této terapie a (3) po této terapii pro nemetastatické onemocnění, a (4) v průběhu terapie metastatického onemocnění. Ke stanovení VO2peak byl použit kardiopulmonální zátěžový test (CPET) s analýzou plynů ve vydechovaném vzduchu. K odhadu rizika úmrtí v závislosti na kategorii VO2peak rizik (< 15,4 vs. ≥ 15,4 ml · kg−1 · min−1) byl použit Coxův model proporčních rizik s korekcí na vliv klinických faktorů.

Výsledky

CPET byl proveden u celkem 248 žen (věk 55 ± 8 let). Průměrná hodnota VO2peak byla 17,8 ± směrodatná odchylka 4,3 ml · kg 1 · min−1, což odpovídá hodnotě nižší o 27 % ± 17 %, než je průměr pro věkově shodné ženy se sedavým způsobem života. V celkové kohortě mělo 32 % VO2peak nižší než 15,4 ml · kg−1 · min−1, což je VO2peak požadovaná pro funkční nezávislost. VO2peak byla v jednotlivých kohortách pacientek s karcinomem prsu významně odlišná z hlediska relativní (ml · kg−1 · min−1) a absolutní (l · min−1) VO2peak (p = 0,017, resp. p < 0,001); VO2peak byla nejnižší u žen s metastatickým onemocněním. U pacientek s metastatickým onemocněním (n = 52) byl ve srovnání s pacientkami, které dosáhly VO2peak ≤ 1,09 l · min–1, korigovaný poměr rizik (HR) pro úmrtí 0,32 (95% CI 0,16–0,67; p = 0,002) pro VO2peak vyšší než 1,09 l · min–1.

Závěr

Pacientky mají v průběhu celé léčby pro karcinom prsu výrazné snížení VO2peak. Ta by se mohla stát nezávislým předpovědním faktorem přežití u metastatického onemocnění.

J Clin Oncol 30:2530-2537. © 2012 by American Society of Clinical Oncology

Celý článek naleznete v časopise Journal of Clinical Oncology číslo 4/2012 na straně 229

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Zdroj: Journal of Clinical Oncology