The Predictive Value For Anthracycline Chronicity Cardiotoxicity Using NT-proBNP

Objective To evaluate the predictive value of NT-pro BNP in Anthracycline Chronicity Cardiotoxicity, and compared with c Tn T.Methods Continuous selection in November 2012 to March 2014 lines of radiation and chemotherapy measures of 57 cases of breast cancer patients, the median age of 48 years old(range 33 to 65 years), all patients by chemotherapy 1 week before clinical symptoms and signs collection, ECG and echocardiography and laboratory tests in order to make clear inclusion/exclusion criteria.Before the first chemotherapy and after each cycle of chemotherapy measuring NT-pro BNP, serum concentration of c Tn T and echocardiography, record the change of the NT-pro BNP, c Tn T serum concentration.NT- pro BNP, c Tn T serum concentration changes according to the upper limit of normal value is divided into 3 level(grade ?: normal without rise; class ?: transient rise; a level ?: rising).After radiation and chemotherapy according to the time interval to chronic cardiac toxicity diagnosis standard to evaluate patients by the month, observe the finish to chronic cardiac toxicity, follow-up for 1 year(outpatient care,electronic medical records, or telephone follow-up), frequency of follow-up for 1 week, and records the disease-free survival.For the statistical analysis using SPSS13.0 data packets.Calculation the disease-free survival rate of c Tn T change pattern of grade ? ~ ? grade, NT-pro BNP change pattern of grade ?~ ? level, survival rate estimation using the K-M method, survival curve comparison using the log- rank method;Cox proportional hazards regression model is used to infer the cardiac toxicity of prognostic factors, drawing the single factor analysis statistically significant prognostic factors in the steps of ROC curve is concluded that the predictive value..Inspection level of alpha = 0.10.Results 17 patients withdrew from the study, so a total of 42 patients included in the study.All has not been included in the study of patients during treatment in clinical cardiac function disorder symptoms and signs, LVEF were normal, and not affected by the drug adverse reaction of chemotherapy. The study include 40 women and 2 male, mean age 51.55 + /- 7.11 years(range 33 ~ 65 years), the average cumulative dose of 546.19 mg/m2(320 ~ 860 mg/m2).A total of 14 patients was performed after the end of the four or six cycles of chemotherapy with local radiotherapy.A total of 76.19%(32/42) of patients c Tn T change model class ?, 19.05%(8/42) of patients c Tn T change model class ?, 9.52%(4/42) of patients c Tn T change mode level ?.c Tn T change pattern of grade ? ~ ? grade average disease-free surial(341.375 +11.776) day respectively(95% CI: 318.293 364.457),(207.000-51.504) days(95% CI:106.053 307.947),(276.500-62.579) days(95% CI: 153.845 399.155), ? v ?(chi-square =10.655, P = 10.655).? vs ?(chi-square = 1.926, P = 1.926).? vs ?(chi-square = 0.218, P =0. 641).A total of 76.19%(32/42) of patients NT-pro BNP grade ? change mode.16.67%(7/42)of patients with brain natriuretic peptide precursor N end class ? change mode, 11.90%(5/42)of patients NT-pro BNP change mode level ?, NT-pro BNP change pattern of grade? ~ ? level median disease-free survival, respectively(354.781 + 5.888) days(95% CI: 343.241366.322),(265.750-50.204) days(95% CI: 16.351 364.149),(119.500-47.284) days(95% CI:26.824 212.176), ? v ?(chi-square = 5.934, P = 5.934).? vs ?(chi-square = 30.885, P =30.885).? vs ?(chi-square = 2.931, P = 0. 087).Single factor analysis of four influence factors, respectively changes c Tn T level grading, NTpro BNP levels grading, cumulative dose and radiation;Multi-factor analysis only NTpro BNP change pattern grading for accepting anthracycline-based antibiotics malignant tumor patients with chronic cardiac toxicity of independent impact factors(RR = 4.679, 95% CI: 2.370 9.237, P = 0.000).Explain NTpro BNP change pattern classification, every level increase their risk of suffering from chronic heart toxicity increased 4.679 times.ROC curve that four influence factors affecting the area under the curve of the predictive value from high to low in turn to N end of brain natriuretic peptide precursor(AUC = 0.752, P = 0.752), the cumulative dose(AUC = 0.720, P = 0.720), whether radiotherapy(AUC = 0.644, P = 0.644), c Tn T(AUC = 0.576, P = 0.576).Conclusion The predictive value of NT-pro BNP above c Tn T, and N terminal brain natriuretic peptide precursor change is Anthracycline Chronicity Cardiotoxicity level is an independent predictor of happening, is worth further clinical application.