Key result
The C2AD2 risk model successfully stratified patients into low, intermediate, and high risk groups for post-RT MACCE, with event rates of 3.9%, 6.6%, and 16.4% in the validation cohort.
Why the study?
Radiation therapy is an integral component of cancer therapy but associated with adverse events, prompting the need for risk prediction models for MACCE after chest RT.
Can the C2AD and C2AD2 risk scores predict major adverse cardiovascular and cerebrovascular events in patients with breast or lung cancer undergoing chest radiotherapy?
Cohort (n=1,530)
No
Can the C2AD and C2AD2 risk scores predict major adverse cardiovascular and cerebrovascular events in patients with breast or lung cancer undergoing chest radiotherapy?
The novel C2AD and C2AD2 risk scores provide a simple and effective tool to stratify the risk of major adverse cardiovascular and cerebrovascular events in patients with breast or lung cancer undergoing chest radiotherapy.
Answers are grounded in this paper and cite their sources.
May aid post-RT MACCE stratification in breast/lung cancer; leaves open prospective validation before clinical adoption.
AIMS: Radiation therapy (RT) is an integral component of cancer therapy but associated with adverse events. Our goal was to establish risk prediction models for major adverse cardiovascular and cerebrovascular events (MACCE) after chest RT. METHODS AND RESULTS: A retrospective study of lung/breast cancer patients who had chest RT with planning CT at Mayo Clinic between 01/2010 and 01/2014. Predictive models were developed based on weighted independent predictors using a derivation (406 lung and 711 breast cancer) and validation cohort (179 lung and 234 breast cancer). Patient characteristics, pre-RT CT for coronary artery calcification (CAC), and post-RT MACCE data were reviewed. Post-RT MACCE occurred in 6.1 and 5.6% in the derivation and validation cohort over a mean follow-up of 42 ± 13 months. Post-therapy model (C2AD2) included CAC (two points), MACCE history (two points), age ≥74 (three points), DM (two points), and mean heart radiation dose ≥ 850 mGy (two points), and pre-therapy model (C2AD) included post-therapy model parameters minus mean heart radiation dose. Both models stratified patients into three risk groups: low (0-2), intermediate (3-5), and high (≥6). Post-RT MACCE across these groups were 2.7, 8.9, and 19.8% in the derivation, and 3.9, 6.6, and 16.4% in the validation cohort for post-therapy model (C2AD2) and 2.8, 9.2, and 20.4% in the derivation and 3.7, 9.2, and 13.2% in the validation cohort for pre-therapy model. Both models showed statistically significant graded survival outcome. CONCLUSION: Post-therapy (C2AD2) and pre-therapy (C2AD) models are simple, easy to use and effective tools to stratify breast and lung cancer patients undergoing chest radiation for post-RT MACCE.
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Rmilah et al. (2024) conducted a cohort in Breast or lung cancer (n=1,530). C2AD2 and C2AD risk prediction models was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCE). The C2AD2 risk model successfully stratified patients into low, intermediate, and high risk groups for post-RT MACCE, with event rates of 3.9%, 6.6%, and 16.4% in the validation cohort.
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