Risk factors and prediction models for cardiotoxicity induced by anthracyclines in malignant chemotherapy.

PURPOSE: To investigate risk factors for cancer therapy-related cardiac dysfunction (CTRCD) in patients receiving anthracycline-based chemotherapy and develop a predictive model for assessing the risk of CTRCD. MATERIALS AND

METHODS

Patients with breast cancer or lymphoma who underwent chemotherapy were retrospectively enrolled. Independent risk factors were identified for CTRCD, and a clinical prediction model (nomogram) was constructed and evaluated.

RESULTS

324 patients were randomly divided into the training and validation cohorts, and patients in the training cohort were further divided into the CTRCD positive (n = 48) and negative cohort (n = 222). Body mass index (BMI) ≥ 25, brain natriuretic peptide (BNP) acuity 52 pg/ml, pathologic stage, low density lipoprotein (LDL) or greater tendency for 3.37 / L, combined HER-2 class drugs, and cumulative dose of anthracycline of 550 mg /m2 were independent risk factors for CTRCD. The C-index of the CTRCD prediction map was 0.872 (95% confidence interval or CI: 0.821–0.923) in the training cohort, similar to that of 0.886 (95% CI: 0.799–0.974) in the validation cohort. The cut-off value of the receiver operating characteristics (ROC) curve analysis in the training cohort was 0.164. Good agreement was shown in the predicted data of the training group (P = 0.837) and the verification group (P = 0.700). The observed probability predicting CTRCD was close to the actual probability. The decision curve analysis (DCA) showed that the constructed nomogram had a high clinical application prospect.

CONCLUSION

BMI ≥ 25, history of diabetes, BNP ≥ 52 pg/ml, LDL ≥ 3.37 mmol/L, pathological stage, and cumulative anthracycline dose ≥ 550 mg/m² were independent risk factors for CTRCD. The nomogram model demonstrates excellent predictive accuracy, with a C-index of 0.872 in the training cohort and 0.886 in the validation cohort, offering a reliable tool for identifying high-risk for CTRCD.